The Entertainment Value of Snuffing Grandma
A nation of children roots for the Mafia
 
By Joe Bageant
August 20, 2009, joebageant.com
Every day I get letters asking me to weigh in on the healthcare fracas. As if a redneck writer armed with a keyboard, a pack of smokes and all the misinformation and vitriol available on the Internet could contribute anything to the crap storm already in progress. Besides that, my unreasoned but noisy take on this issue is often about as welcome as a fart in a spacesuit. None of which has ever stopped me from making a fool of myself in the past. So here goes.
There ain't any healthcare debate going on, Bubba. What is going on are mob negotiations about insurance, and which mob gets the biggest chunk of the dough, be it our taxpayer dough or the geet that isn't in ole Jim's impoverished purse. The hoo-ha is about the insurance racket, not the delivery of healthcare to human beings. It's simply another form of extorting the people regarding a fundamental need -- health.
Unfortunately, the people have been mesmerized by our theater state's purposefully distracting and dramatic media productions for so long they've been mutated toward helplessness. Consequently, they are incapable of asking themselves a simple question: If insurance corporation profits are one third of the cost of healthcare, and all insurance corporations do is deliver our money to healthcare providers for us (or actually, do everything in their power to keep the money for themselves), why do we need insurance companies at all? Answer: Because Wall Street gets a big piece of the action. And nobody messes with the Wall Street Mob (as the bailout extortion money proved). Better (and worse) presidents have tried. Some made a genuine effort to push it through Congress. Others expressed the desire publicly, but after getting privately muscled by the healthcare industry, decided to back off from the idea. For instance:

• Franklin Roosevelt wanted universal healthcare.
• Harry Truman wanted universal healthcare.
• Dwight Eisenhower wanted universal healthcare.
• Richard Nixon wanted universal healthcare.
• Lyndon Johnson wanted universal healthcare.
• Bill Clinton wanted -- well we can't definitely say because he made sure that if the issue blew up on him, which it did, Hillary would be left holding the turd. Is it any wonder that woman gets so snappy at the slightest provocation? First getting left to hold the bag on healthcare, then the spots on that blue dress.

So why did American liberals believe Obama would bring home the healthcare bacon? Because they live in an ideological cupcake land. It's a big neighborhood, a very special place where "Your vote is important," and "by electing the right candidate, you can change our beloved nation." Most of America lives in that neighborhood, even though they've never personally met. It's a place where the shrubbery and flowerbeds of such things as "values" and "hope" bloom. Hope that our desires coupled with the efforts of a good and decent president can affect "change." Evidently these voters never heard the old adage, "Hope in one hand and piss in the other, and see which one fills up first."
The slaughter of the innocents by the healthcare lobby has pretty much extinguished the political usefulness of the word hope. Nobody, especially Obama, uses it now.
The first on-stage scuffle of the Obama administration, government assured healthcare, quickly settled down into the accustomed scenario of very rich and powerful people in expensive suits "finding middle ground," otherwise known as the status quo. Single payer healthcare soon became "a consumer government alternative to private insurance," and is now "a system of health cooperatives. Next comes "slightly better health insurance (but not medical services) than before, from the same insurance companies but at twice the price; don't worry though, we're increasing your tax load so you can afford it."
The televised screaming matches, having served their purpose, are over now. The presidency and the nation have settled back into the normalcy of the officially sanctioned state consciousness and its curious non-language, one modified and shaped daily by corporate and government symbiosis. Over generations we've come to internalize this imagistic language, which is quite theatrical when heated up for public consumption and dully bureaucratic when attention is to be avoided. But always it is void of content and any sort of truth. In the corporately managed theater state, it's not whether a thing is true that matters, but how it sounds and looks and what you call it. Call end of life counseling a "death panel," and you've just turned mercy and choice into one more Great Satan.
In the end though, healthcare American style comes down to the preferences of two elite castes, Congress and corporate powers, neither of which can exist without the other. Corporations need the government to sanction their methods of extracting wealth from the public. Congress needs corporations to finance its campaign chariot races. Right now members of Congress have an excellent chance of putting the arm on healthcare industry lobbyist for some real cash:
Senator Smedley Heathwood: "Oh, I dunno, I'm sort of liking Obama's alternative."
Godzilla Healthcare Inc.:  "Here, take this suitcase full of gold bullion, call me if you run short. And remember, we've got that ‘Life is a pre-existing condition' bill coming up in the Senate soon."
Siamese twins, joined at the hip, they share the same goal, preservation of control -- the government's social control and the corporations' economic control. And you cannot have one without the other.
Obama got elected on hope of reform, despite that one cannot reform a mafia, only pay increased extortion moneys. He's fortunate that it was not a genuine demand for reform, just hope. We're fortunate we did not demand reform because we're not going to get it. Obama doesn't have to reform the healthcare industry mob. All he has to do is look like he took a shot at it, and hope it's convincing enough. What we've seen is probably his best shot, too. Why not? There is always the off chance it might work, in which case his "presidential legacy" would be assured. And if it doesn't, well, the serious progressives who are screeching mad at him now will still have to vote for him as the incumbent in 2012. Or learn to love somebody like Mitt Romney, Sarah Palin, Mike Huckabee, Jeb Bush, Rick Santorum (take your pick) or some as-yet-unknown the GOP drags out from under the hen house and ballyhoos as a "new face." Luckily, Dick Cheney is out of the question, barring a coup by the far right wing of the schizophrenic GOP. But still, after Palin, one shudders at the prospects.
Whatever happens, we will not see Congress stand up against the extortion of its people by the healthcare industry. We will not see even the most ordinary kind of healthcare declared as a human right, as it is in so many other nations. We will see, however, greater access to the public treasury by the insurance corporations.
Every nation in the world is now party to at least one treaty that addresses health as a human right, including the conditions necessary for the delivery of health services. Healthcare is a right under the Universal Declaration of Human Rights. Hell, even Saddam Hussein provided healthcare.
That Americans cannot grasp this fundamental aspect of human rights (but then we cannot even get child nutrition, or limiting the number of times you can taser an old lady in an airport, out of the starting gate) and join the civilized world and assure its people of such things is testimony. Testimony that we live in a vacuum exclusive of the accepted standard of mercy and decency common to civilized democratic nations elsewhere. Testimony that even we the citizenry would rather maintain and spread lies than accept truths such as most people in countries with universal healthcare would not ever give it up in favor of the U.S. system.
Most of all though, it is testimony that we live under an induced mass hallucination where spectacle replaces fact, information and common sense. In place of actionable information, we are served up screaming red faces -- angry mobs manufactured for TV protesting "government interference in the people's healthcare choices." One must wonder what inchoate anger is really being tapped by the organizers of these strange "citizen protests." As usual, the straw boogeyman of socialism is once more invoked. "Oh my god! I'll have to give up my $1,100 a month insurance bill, which only pays 80% of my insurance costs AFTER I pay the initial $5,000 of those costs! If that ain't Joe Stalin all over again, I don't know what is!" We get the false media drama of "death panels."
And being captives of spectacle and hyperbole, we friggin love it. The idea of death panels plays to our childish attraction to the extreme and entertaining. Killing Grandma is far more entertaining to our imaginations than say, guaranteed access to chest screens and blood pressure medicine. Two generations into this national infantilization, it's now the only national life we know -- the ideological spectacle made real.
To steal a page from Guy Debord, society has become ideology. We live in an antidialectical false consciousness, imposed at every moment on everyday life as spectacle. We are held in thrall. Our faculty of ordinary encounter has been systematically broken down. In its place we now have our unique social hallucination. Never do we encounter anything directly, yet we get the illusion of encounter. This includes encounter with each other. Anyone who lives in meatspace with his or her fellow Americans could not deny 57 million of them health. In this society no one is any longer capable of recognizing anyone else. Instead, we see others as the screamers at the town hall meetings, or as communists who want to give free healthcare to illegals and establish death panels. Or as Christian fundamentalists, or as liberals or conservatives. Or as celebrities or as nobodies.
But most importantly, whenever we must reach any significant agreement as human beings, whether it be about something as globally insignificant as U.S. domestic policy (we are only 6% of the world population, and though it hasn't soaked in yet to most Americans, we're also broke and owe the Chinese loan shark a wad) or as significant as global warming, we immediately cede the field to ideology. We simply don't know how to do anything else.
Ideology has utterly triumphed. It has separated us from ourselves and built itself a home inside our consciousness, from whence it operates now as our reality. There is no going back, only forward. Given that we are a nation of children who prefer to close our eyes and make a hopeful wish with Tinkerbelle, rather than give hope the piss test, then let us hope to high hell. We may as well go for broke. So let us hope that, in going forward, new and unforeseen developments in the national consciousness occur. Developments that offer an escape from this one so deeply colonized by the corpo-political machinery we created -- and which in turn recreated us. One that will break us loose from enthrallment. Maybe collision with a giant asteroid. Or that Garth Brooks will be barred from making a fifth comeback tour. That's one hope. A consciousness shattering event by American standards.
Another hope is for an absolute and total collapse of the system.
At this point, I'll take what I can get.

Published on Saturday, August 15, 2009 by CommonDreams.org
"Now Make Me Do It"
by Ralph Nader
Never much of a fighter against abusive corporate power, Barack Obama is making it increasingly clear that right from his start as President, he wanted health insurance reform that received the approval of the giant drug and health insurance industries.
Earlier this year he started inviting top bosses of these companies for intimate confabs in the White House. Business Week magazine, which proclaimed recently that "The Health Insurers Have Already Won" reported that the CEO of UnitedHealth, Stephen J. Hemsley, met with the President half a dozen times.
These are the vendors. They and their campaign slush funds cannot be ignored in the power struggle over the legislation percolating in the Congress. One public result of these meetings was that the drug industry promised $80 billion in savings over ten years and the health insurance moguls promised $150 billion over the same decade. Mr. Obama trumpeted these declarations without indicating how these savings would be guaranteed, how the drug companies could navigate the antitrust laws and what was given to the health care industry by the White House in return.
We have now learned that one Obama promise was to continue the prohibition on Uncle Sam from bargaining for volume discounts on drugs that you the taxpayer have been paying for in the drug benefit program enacted in 2003.
Unknown is whether the health insurance companies were also promised continuation of Medicare Advantage with its 14% added taxpayer subsidy to induce the elderly to make the move out of public Medicare. Also unknown is whether the Medicare public option that Mr. Obama formerly espoused but since has wavered on has been put on the concession table.
The whole secret process is seedy and demonstrates cruel disregard for the millions of American who, whether in dire need of medical services or not, voted in "change we can believe in."
By stark contrast, President Obama has never invited to the White House the leading consumer-patient champions in this country who favor full Medicare and free choice of physician and hospital-often called "a single payer" system. Open to the corporate barons who have failed decade after decade to deliver what patients need, the White House door is closed to the likes of Dr. Quentin Young-a founder of the Physicians for a National Health Program and an old Chicago friend of Obama's, Dr. Sidney Wolfe, who heads Public Citizen's Health Research Group, Drs. Marcia Angell, Stephanie Woolhandler, and David Himmelstein, who are nationally known and accomplished single payer advocates or Rose Ann DeMoro, executive director of the fast-growing California Nurses Association.
Mr. Obama even tried to exclude any advocate of a single payer system-previously favored by Obama and still favored by a majority of the American people, doctors and nurses-from his roundtable meetings convened to receive the views of different constituencies.
"Make me do it" was the advice of Franklin Delano Roosevelt to reformers when faced with legislation he desired but did not have the votes for in Congress. Mr. Obama is not exerting that plea for people power. Were he to do that, he would be encouraging daily public hearings in the Senate and the House on the bureaucratic waste, greed, overbilling, collusion, and fraud that many in the corporate world have inflicted with their costly, pay or die health care industry.
Such publicized hearings would keep him on the offensive. It would arouse the public and focus energies on the main problem-the corporatization of medicine. This commercialism has left tens of millions of people without health insurance, caused 20,000 fatalities a year, and cost Americans twice or more per capita than have full Medicare systems in western countries, which have better health outcomes than the U.S.
Further indication of Obama's corporate dealings is that he never identified himself with a specific bill with a House and Senate number that he could rally the people around. No wonder people are confused, frustrated and angry. President Obama did not stand for an unambiguous proposal.
He thereby emboldened both the cash and carry Blue dog Democrats to rebel and the Republican yahoos to launch their lies and distortions via Rush Limbaugh and similar trash media.
Obama is about to make his biggest mistake to date by favoring the bipartisan deal his assistants are working out with Blue Dog Senator Max Baucus and his Republican counterparts on the Senate Finance Committee. This proposal has no public option, no consumer protections or restraints on the mayhem and skyrocketing charges of the so-called health care industry.
Already the less corporate-indentured bills being reported from the House Committee by Rep. Henry Waxman (D-CA) and his allies are getting short-shrift from a White House that clearly views the forthcoming Baucus-Grassley "compromise" as the "more practical" go-to legislation.
There is reliable word that the AFL-CIO will endorse whatever Obama approves, with the exceptions of the California Nurses Association and the Sheet Metal Workers' union. The latter, through their president, Michael J. Sullivan, announced in late July that it was suspending all future campaign contributions to any candidate for Congress or the Presidency.
Already over sixty progressive members of the House, headed by Congresswoman Lynn Woolsey (D-CA) have declared opposition to these unacceptable compromises moving forward in both the House and the Senate.
So is gridlock around the corner? Will there be a health insurance reform of any stripe signed into law this year? It depends on the alliances that settle for the lowest corporate denominators being blocked by the unyielding principled stands of the progressives who want something that puts patients above the failed profiteering vendors.
The guess here is that Obama will sign anything which squirms through a cowardly Congress that cannot give to the American people in 2009 the health care system Congress stopped President Harry Truman from establishing in 1950.
It is up to the people of our country to "make him do it" whether this year or next. A mere one million immediate calls to members of Congress by one million assertive citizens will start sobering up these legislators who think they can get away with another sale of our public trust.
The Congressional switchboard is 202-224-3121. The full Medicare, single payer bill (backed by nearly ninety legislators) is H.R. 676. The go-to citizen group for your sustained engagement is singlepayeraction.org . The rest is up to you, the majority, who want to put the people first.
Ralph Nader is a consumer advocate, lawyer, and author. His most recent book is The Seventeen Traditions .

Published on Saturday, August 15, 2009 by the Independent/UK
The Brutal Truth About America’s Healthcare
An extraordinary report from Guy Adams in Los Angeles at the music arena that has been turned into a makeshift medical center
They came in their thousands, queuing through the night to secure one of the coveted wristbands offering entry into a strange parallel universe where medical care is a free and basic right and not an expensive luxury. Some of these Americans had walked miles simply to have their blood pressure checked, some had slept in their cars in the hope of getting an eye-test or a mammogram, others had brought their children for immunizations that could end up saving their life.
In the week that Britain's National Health Service was held aloft by Republicans as an "evil and Orwellian" example of everything that is wrong with free healthcare, these extraordinary scenes in Inglewood, California yesterday provided a sobering reminder of exactly why President Barack Obama is trying to reform the US system.
The LA Forum, the arena that once hosted sell-out Madonna concerts, has been transformed - for eight days only - into a vast field hospital. In America, the offer of free healthcare is so rare, that news of the magical medical kingdom spread rapidly and long lines of prospective patients snaked around the venue for the chance of getting everyday treatments that many British people take for granted.
In the first two days, more than 1,500 men, women and children received free treatments worth $503,000 (£304,000). Thirty dentists pulled 471 teeth; 320 people were given standard issue spectacles; 80 had mammograms; dozens more had acupuncture, or saw kidney specialists. By the time the makeshift medical centre leaves town on Tuesday, staff expect to have dispensed $2m worth of treatments to 10,000 patients.
The gritty district of Inglewood lies just a few miles from the palm-lined streets of Beverly Hills and the bright lights of Hollywood, but is a world away. And the residents who had flocked for the free medical care, courtesy of mobile charity Remote Area Medical, bore testament to the human cost of the healthcare mess that President Obama is attempting to fix.
Christine Smith arrived at 3am in the hope of seeing a dentist for the first time since she turned 18. That was almost eight years ago. Her need is obvious and pressing: 17 of her teeth are rotten; some have large visible holes in them. She is living in constant pain and has been unable to eat solid food for several years.
"I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I've had several jobs since, but none with medical insurance, so I've not been able to see a dentist to get it fixed," she told The Independent. "I've not been able to chew food for as long as I can remember. I've been living on soup, and noodles, and blending meals in a food mixer. I'm in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I'll do it. This will change my life."
Along the hall, Liz Cruise was one of scores of people waiting for a free eye exam. She works for a major supermarket chain but can't afford the $200 a month that would be deducted from her salary for insurance. "It's a simple choice: pay my rent, or pay my healthcare. What am I supposed to do?" she asked. "I'm one of the working poor: people who do work but can't afford healthcare and are ineligible for any free healthcare or assistance. I can't remember the last time I saw a doctor."
Although the Americans spend more on medicine than any nation on earth, there are an estimated 50 million with no health insurance at all. Many of those who have jobs can't afford coverage, and even those with standard policies often find it doesn't cover commonplace procedures. California's unemployed - who rely on Medicaid - had their dental care axed last month.
Julie Shay was one of the many, waiting to slide into a dentist's chair where teeth were being drilled in full view of passers-by. For years, she has been crossing over the Mexican border to get her teeth done on the cheap in Tijuana. But recently, the US started requiring citizens returning home from Mexico to produce a passport (previously all you needed was a driver's license), and so that route is now closed. Today she has two abscesses and is in so much pain she can barely sleep. "I don't have a passport, and I can't afford one. So my husband and I slept in the car to make sure we got seen by a dentist. It sounds pathetic, but I really am that desperate."
"You'd think, with the money in this country, that we'd be able to look after people's health properly," she said. "But the truth is that the rich, and the insurance firms, just don't realise what we are going through, or simply don't care. Look around this room and tell me that America's healthcare don't need fixing."
President Obama's healthcare plans had been a central plank of his first-term program, but his reform package has taken a battering at the hands of Republican opponents in recent weeks. As the Democrats have failed to coalesce around a single, straightforward proposal, their rivals have seized on public hesitancy over "socialized medicine" and now the chance of far-reaching reform is in doubt.
Most damaging of all has been the tide of vociferous right-wing opponents whipping up skepticism at town hall meetings that were supposed to soothe doubts. In Pennsylvania this week, Senator Arlen Specter was greeted by a crowd of 1,000 at a venue designed to accommodate only 250, and of the 30 selected speakers at the event, almost all were hostile.
The packed bleachers in the LA Forum tell a different story. The mobile clinic has been organized by the remarkable Remote Area Medical. The charity usually focuses on the rural poor, although they worked in New Orleans after Hurricane Katrina. Now they are moving into more urban venues, this week's event in Los Angeles is believed to be the largest free healthcare operation in the country.
Doctors, dentists and therapists volunteer their time, and resources to the organization. To many US medical professionals, it offers a rare opportunity to plug into the public service ethos on which their trade was supposedly founded. "People come here who haven't seen a doctor for years. And we're able to say 'Hey, you have this, you have this, you have this'," said Dr Vincent Anthony, a kidney specialist volunteering five days of his team's time. "It's hard work, but incredibly rewarding. Healthcare needs reform, obviously. There are so many people falling through the cracks, who don't get care. That's why so many are here."
Ironically, given this week's transatlantic spat over the NHS, Remote Area Medical was founded by an Englishman: Stan Brock. The 72-year-old former public schoolboy, Taekwondo black belt, and one-time presenter of Wild Kingdom, one of America's most popular animal TV shows, left the celebrity gravy train in 1985 to, as he puts it, "make people better".
Today, Brock has no money, no income, and no bank account. He spends 365 days a year at the charity events, sleeping on a small rolled-up mat on the floor and living on a diet made up entirely of porridge and fresh fruit. In some quarters, he has been described, without too much exaggeration, as a living saint.
Though anxious not to interfere in the potent healthcare debate, Mr Brock said yesterday that he, and many other professionals, believes the NHS should provide a benchmark for the future of US healthcare.
"Back in 1944, the UK government knew there was a serious problem with lack of healthcare for 49.7 million British citizens, of which I was one, so they said 'Hey Mr Nye Bevan, you're the Minister for Health... go fix it'. And so came the NHS. Well, fast forward now 66 years, and we've got about the same number of people, about 49 million people, here in the US, who don't have access to healthcare."
"I've been very conservative in my outlook for the whole of my life. I've been described as being about 90,000 miles to the right of Attila the Hun. But I think one reaches the reality that something doesn't work... In this country something has to be done. And as a proud member of the US community but a loyal British subject to the core, I would say that if Britain could fix it in 1944, surely we could fix it here in America.
Healthcare compared
Health spending as a share of GDP
US 16%
UK 8.4%
Public spending on healthcare (% of total spending on healthcare)
US 45%
UK 82%
Health spending per head
US $7,290
UK $2,992
Practising physicians (per 1,000 people)
US 2.4
UK 2.5
Nurses (per 1,000 people)
US 10.6
UK 10.0
Acute care hospital beds (per 1,000 people)
US 2.7
UK 2.6
Life expectancy:
US 78
UK 80
Infant mortality (per 1,000 live births)
US 6.7
UK 4.8
Source: WHO/OECD Health Data 2009

Obama's $80 Billion Deal with Pharma Is a Very Bad Deal for Us

By William Greider, The Nation
Posted on August 8, 2009, Printed on August 10, 2009
http://www.alternet.org/story/141856/

So now we know why the president wants everyone to make nice in the healthcare debate. His White House has cut a deal with Big Pharma that smells like the same old rotten politics that candidate Obama regularly denounced and promised to end. The drug industry agrees to deliver $80 billion in future savings and the president promises the government will not use its awesome purchasing power to negotiate lower drug prices.
Wow. This is roughly the same deal that George W. Bush cut with the drug makers when he was legislating Medicare's new coverage of drug purchases. It is the same bargain that Democrats in Congress universally condemned as wasteful and corrupt. The deal does not smell any better now that a Democratic president is embracing it.
In effect, Obama wants to give away one of the principal objectives of strong reform. The details were spelled out in today's New York Times and revealed by Big Pharma's top-dog lobbyist, Billy Tauzin, a former Republican congressman who leads the industry association. Tauzin called it a "rock-solid deal," and the White House did not dispute as much. But that is not the last word.
People who believe in real healthcare reform should not be nice about this. They must rise up and rebel against our popular new president's outrageous concession. They must demand that Congress declare the private deal-making null and void. If Congress lacks the nerve to do this, then this exercise in reform begins to look more and more like previous attempts that were eviscerated by the clout of the corporate interests.
The fate of healthcare reform may depend not on the Senate or the White House but on Nancy Pelosi and the Democratic majority in the House of Representatives. What prompted Billy Tauzin to spill the beans on his deal-making with White House chief of staff Rahm Emanuel was the House measure that specifies government's right to bargain for lower prices. No, no, no! Tauzin said. We've got a deal with the president, who says that won't be allowed.
But House Speaker Nancy Pelosi simply responds that the House is not bound by any deals made with the Senate or the White House. Her caucus must back up her words. They should pass the House bill, which will allow the government to do what any major customer would do in the same circumstances -- use its leverage to demand lower prices.
If House Democrats stand their ground, then they will force a debate they can win with the American public. President Obama will have to choose between standing with the drug manufacturers or defending the original purpose of healthcare reform.
William Greider is the author of, most recently, "Come Home, America: The Rise and Fall (and Redeeming Promise) of Our Country (Rodale Books, 2009).

How the White House’s Deal With Big Pharma Undermines Democracy

By Robert Reich|Aug 9, 2009, 5:30 PM|Author's Website  
I’m a strong supporter of universal health insurance, and a fan of the Obama administration. But I’m appalled by the deal the White House has made with the pharmaceutical industry’s lobbying arm to buy their support.
Last week, after being reported in the Los Angeles Times, the White House confirmed it has promised Big Pharma that any healthcare legislation will bar the government from using its huge purchasing power to negotiate lower drug prices. That’s basically the same deal George W. Bush struck in getting the Medicare drug benefit, and it’s proven a bonanza for the drug industry. A continuation will be an even larger bonanza, given all the Boomers who will be enrolling in Medicare over the next decade. And it will be a gold mine if the deal extends to Medicaid, which will be expanded under most versions of the healthcare bills now emerging from Congress, and to any public option that might be included. (We don’t know how far the deal extends beyond Medicare because its details haven’t been made public.)
Let me remind you: Any bonanza for the drug industry means higher health-care costs for the rest of us, which is one reason why critics of the emerging healthcare plans, including the Congressional Budget Office, are so worried about their failure to adequately stem future healthcare costs. To be sure, as part of its deal with the White House, Big Pharma apparently has promised to cut future drug costs by $80 billion. But neither the industry nor the White House nor any congressional committee has announced exactly where the $80 billion in savings will show up nor how this portion of the deal will be enforced. In any event, you can bet that the bonanza Big Pharma will reap far exceeds $80 billion. Otherwise, why would it have agreed?
In return, Big Pharma isn’t just supporting universal health care. It’s also spending a lots of money on TV and radio advertising in support. Sunday’s New York Times reports that Big Pharma has budgeted $150 million for TV ads promoting universal health insurance, starting this August (that’s more money than John McCain spent on TV advertising in last year’s presidential campaign), after having already spent a bundle through advocacy groups like Healthy Economies Now and Families USA.
I want universal health insurance. And having had a front-row seat in 1994 when Big Pharma and the rest of the health-industry complex went to battle against it, I can tell you first hand how big and effective the onslaught can be. So I appreciate Big Pharma’s support this time around, and I like it that the industry is doing the reverse of what it did last time, and airing ads to persuade the public of the rightness of the White House’s effort.
But I also care about democracy, and the deal between Big Pharma and the White House frankly worries me. It’s bad enough when industry lobbyists extract concessions from members of Congress, which happens all the time. But when an industry gets secret concessions out of the White House in return for a promise to lend the industry’s support to a key piece of legislation, we’re in big trouble. That’s called extortion: An industry is using its capacity to threaten or prevent legislation as a means of altering that legislation for its own benefit. And it’s doing so at the highest reaches of our government, in the office of the President.
When the industry support comes with an industry-sponsored ad campaign in favor of that legislation, the threat to democracy is even greater. Citizens end up paying for advertisements designed to persuade them that the legislation is in their interest. In this case, those payments come in the form of drug prices that will be higher than otherwise, stretching years into the future.
I don’t want to be puritanical about all this. Politics is a rough game in which means and ends often get mixed and melded. Perhaps the White House deal with Big Pharma is a necessary step to get anything resembling universal health insurance. But if that’s the case, our democracy is in terrible shape. How soon until big industries and their Washington lobbyists have become so politically powerful that secret WhiteHouse-industry deals like this are prerequisites to any important legislation? When will it become standard practice that such deals come with hundreds of millions of dollars of industry-sponsored TV advertising designed to persuade the public that the legislation is in the public’s interest? (Any Democrats and progressives who might be reading this should ask themselves how they’ll feel when a Republican White House cuts such deals to advance its own legislative priorities.)
We’re on a precarious road — and wherever it leads, it’s not toward democracy.

Resuscitating Health Care Reform

Huffington Post: August 10, 2009 12:01 AM
Dean Ornish, MD

Health reform is in danger of failing because the focus has been too much on who is covered and not enough on what is covered. Health care reform is primarily about health insurance reform, with the main battle being over coverage and the payment system.
Of course, we need to provide coverage for the 48 million Americans who do not have health insurance. It is morally indefensible that we have not already done so.
But we also need to transform what is covered. If we want to make affordable health care available to the 48 million Americans who do not have health insurance, then the fundamental causes of many chronic diseases need to be addressed -- which are primarily the lifestyle choices we make each day -- rather than only literally or figuratively bypassing them.
If we just cover bypass surgery, angioplasty, stents, and other interventions that are dangerous, invasive, expensive, and largely ineffective on 48 million more people, then costs are likely to increase significantly at a time when resources are limited. As a result, painful choices are being discussed -- rationing, raising taxes, and/or increasing the deficit -- and these are threatening the public acceptance and thus the viability of health reform.
Meaningful health reform needs to provide incentives for physicians and other health professionals to teach their patients healthy ways of living rather than reimbursing primarily drugs and surgical interventions. If lifestyle interventions proven to reverse as well as prevent many chronic diseases are reimbursed along with other strategies for improving cost-effectiveness across the U.S. healthcare system, then it may be possible to provide universal coverage at significantly lower cost without making painful choices, and the only side-effects are good ones.
The U.S. "health-care system" is primarily what Senator Harkin [D-Iowa] calls "a sick-care system." Last year, $2.1 trillion dollars were spent in this country on medical care, or 16.5% of the gross national product, and 95 cents of every dollar were spent to treat disease after it had already occurred.
Heart disease, diabetes, prostate/breast cancer, and obesity account for up to 75% of these health care costs, and yet these are largely preventable and even reversible by changing diet and lifestyle.
Our research, and the work of many others, have shown that our bodies often have a remarkable capacity to begin healing, and much more quickly than we had once realized, if we address the lifestyle factors that often cause these chronic diseases. Medicine today focuses primarily on drugs and surgery, genes and germs, microbes and molecules, but we are so much more than that.
Many people tend to think of breakthroughs in medicine as a new drug, laser, or high-tech surgical procedure. They often have a hard time believing that the simple choices that we make in our lifestyle -- what we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our relationships and social support -- can be as powerful as drugs and surgery, but they often are. Often, even better.
These choices are especially clear in cardiology as an example of this larger issue. Large-scale studies have shown that changing lifestyle could prevent at least 90-95% of all heart disease. (1) Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle.
In contrast, many people are surprised to learn that bypass surgery and angioplasty don't work very well. In 2006, for example, according to the American Heart Association (2), 1.3 million angioplasties and stents were performed at an average cost of $48,399 each, or more than $60 billion. In addition, 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion -- i.e., more than $100 billion for these two operations.
Despite these costs, a major randomized controlled trial found that angioplasties and stents do not significantly prolong life or even prevent heart attacks in stable patients (i.e., in most patients who receive them). (3) Earlier randomized controlled trials of coronary bypass surgery found that this procedure prolongs life in only a small fraction of patients -- those with left main coronary artery disease or equivalent and left ventricular dysfunction (ejection fraction less than 30%). A recent randomized controlled trial in diabetics found that neither bypass surgery nor angioplasty prolonged life or prevented heart attacks. (4)
Lifestyle changes also can be reframed not only as preventing chronic diseases but also as reversing the progression of these illnesses -- i.e., as intensive non-surgical, non-pharmacologic interventions.
What we eat, how we respond to stress, whether or not we smoke cigarettes, how much exercise we get, and the quality of our relationships and social support may be as powerful as drugs and surgery in treating (not just preventing) many chronic diseases.
Our studies showed that people with severe coronary heart disease were able to stop or reverse it by making intensive lifestyle changes, without drugs or surgery, and these findings have now been replicated by several others. (5) There was some reversal of heart disease after one year and even more improvement after five years, and there were 2.5 times fewer cardiac events when compared to a randomized control group. (6)
Almost 80% of patients eligible for bypass surgery or angioplasty were able to safely avoid it by making comprehensive lifestyle changes instead, saving almost $30,000 per patient in the first year when compared to a matched control group. (7) In a second demonstration project with Highmark Blue Cross Blue Shield, these comprehensive lifestyle changes reduced total health care costs in those with coronary heart disease by 50% after only one year and by an additional 20-30% in years two and three when compared to a matched control group.
Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle. We don't have to wait for a new breakthrough in drugs or surgery; we just need to put into practice what we already know.
Reimbursement is a major determinant of how medicine is practiced. When reimbursement changes, so do medical practice and medical education.
Some question whether or not prevention saves money, asking whether these approaches actually prevent or only delay the onset of disease. Part of the reason that preventive approaches are usually scored by the Congressional Budget Office (which estimates the overall costs of any legislation) as significantly increasing costs is that lifestyle changes are viewed only as primary prevention -- paying money today in hopes of saving money later.
But even primary prevention saves money, although the cost savings per person are not as high as when intensive lifestyle changes are offered as treatment to those who are already sick. For example, three years ago, Steve Burd (CEO of Safeway) realized that health care costs for his employees were exceeding Safeway's net income--clearly, not sustainable. I consulted with him in redesigning the corporate health plan for his employees in ways that emphasized prevention and wellness, provided incentives for healthful behaviors, and paid 100% of the costs of preventive care.
Overall health care costs decreased by 15% in the first year and have remained flat since then. Many other worksite wellness programs have shown cost savings as well as a happier and more productive workforce. This approach is bringing together Democrats and Republicans, labor and management.
In each of these studies, significant savings occurred in the first year -- medically effective and cost effective. Why? Because there is a growing body of scientific evidence showing how much more dynamic our bodies are than had previously been believed.
The same intensive lifestyle changes that may reverse the progression of coronary heart disease may also slow, stop, or even reverse the progression of early-stage prostate cancer (8), whereas conventional treatments such as radical prostatectomy and radiation may not prolong life except in the small percentage of patients who have the most aggressive disease. (9)
These lifestyle changes also may beneficially affect gene expression in only three months, turning on genes that prevent disease and turning off genes that promote heart disease, prostate cancer, breast cancer, and other illnesses. (10) Often, people say, "Oh, it's all in my genes, there's not much I can do about it." For many people, it captures their imagination to know that changing lifestyle changes their genes for the better.
Last year, my colleagues and I published the first study showing that these intensive lifestyle changes significantly increase telomerase, and thus telomere length, in only three months. (11) (Even drugs have not been shown to do this.) Telomeres are the ends of your chromosomes that help control aging -- as your telomeres get longer, your life gets longer. (Like all research, these relatively small studies need to be replicated in larger randomized controlled trials.)
Lifestyle changes are not only as good as drugs but often even better. For example, a major study showed that lifestyle changes are even more effective than diabetes drugs such as metformin in reducing the incidence of diabetes in persons at high risk, with lower costs and fewer side-effects. (12)
"Prevention" often conjures up false choices -- "Is it fun for me or is it good for me? Am I going to live longer or is it just going to seem longer if I eat and live healthier?" Because these mechanisms are so dynamic, most people find that they feel so much better, so quickly, it reframes the reason for making these changes from fear of dying (which is too scary) or risk factor modification (which is too boring) to feeling better.
Many patients say that there is no point in giving up something that they enjoy unless they get something back that's even better -- not years later, but days or weeks later. Then, the choices become clearer and, for many patients, worth making. They often experience that something beneficial and meaningful is quickly happening.
The benefit of feeling better quickly is a powerful motivator and reframes therapeutic goals from prevention or risk factor modification to improvement in the quality of life. Concepts such as "risk factor modification" and "prevention" are often considered boring and they may not initiate or sustain the levels of motivation needed to make and maintain comprehensive lifestyle changes.
In our experience, it is not enough to focus only on patient behaviors such as diet and exercise; we often need to work at a deeper level. Depression, loneliness, and lack of social support are also epidemic in our culture. These affect not only quality of life but also survival. Several studies has shown that people who are lonely, depressed, and isolated are many times more likely to get sick and die prematurely than those who are not. In part, this is mediated by the fact that they are more likely to engage in self-destructive behaviors when they feel this way, but also via mechanisms that are not well-understood. For example, many people smoke or overeat when they are stressed, lonely, or depressed.
What is sustainable is joy, pleasure, and freedom, not deprivation and austerity. (13) When you eat a healthier diet, quit smoking, exercise, meditate, and have more love in your life, then your brain receives more blood and oxygen, so you think more clearly, have more energy, need less sleep. The latest studies have shown that your brain may grow so many new neurons that it may get measurably bigger in only a few months -- this was thought to be impossible only a few years ago. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent -- the same way that drugs like Viagra work. For many people, these are choices worth making -- not just to live longer, but also to live better.
In other words, the debate on prevention often misses the point: the mortality rate is still 100%, one per person. So, it's not just how long we live but also howwell we live. Making comprehensive lifestyle changes significantly improves the quality of life very quickly, which is what makes these changes sustainable and meaningful.
Unfortunately, anything involving lifestyle changes gets held to a different standard. Drugs and surgery are not required to show that they save money in order to be covered, only that they work. Lifestyle changes often work even better, and at lower cost.
Finally, it's worth pointing out that what's good for your personal health is good for the planet's health; what's personally sustainable is globally sustainable. For example, eating a diet high in red meat increases the risk of heart disease and many forms of cancer. It also increases global warming: livestock cause more global warming than all forms of transportation combined due to methane production, which is 21 times more powerful a greenhouse gas than carbon dioxide. (14)
As Senator Harkin said, "To date, prevention and public health have been the missing pieces in the national conversation about health care reform. It's time to make them the centerpiece of that conversation. Not an asterisk. Not a footnote. But the centerpiece of health care reform."
If we don't, then the escalating costs and resulting painful choices -- rationing, raising taxes, and/or increasing the deficit -- are threatening the public acceptance and thus the viability of health reform.

•  Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet. 2004; 364: 937-52.
•  Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics 2009 update. A report from the American Heart Association statistics committee and stroke statistics committee. Circulation. 2009;119:e1-e161.
•  Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1-14.
•  The BARI 2D study group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503-15.
•  Ornish DM, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary atherosclerosis? The Lifestyle Heart Trial. Lancet. 1990; 336:129-133.
•  Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280:2001-2007.
•  Ornish D. Avoiding Revascularization with Lifestyle Changes: The Multicenter Lifestyle Demonstration Project. American Journal of Cardiology. 1998;82:72T-76T.
•  Ornish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol 2005;174:1065-1070.
•  Barry MJ. Screening for Prostate Cancer -- The Controversy That Refuses to Die. N Engl J Med. 2009;360:1351-4.
•  Ornish D, Magbanua MJ, Weidner G, et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Nat Acad Sci USA 2008;105:8369-8374.
•  Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol 2008;9:1048-1057.
•  Diabetes Prevention Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
•  Ornish D. The Spectrum. New York: Random House/Ballantine Books, 2008.
•  United Nations Food and Agriculture Organization's report, Livestock's Long Shadow. Accessed on April 16th, 2007.

 

Published on Saturday, July 25, 2009 by CommonDreams.org
Health Care Hypocrisy
by Ralph Nader
About the only lesson Barack Obama has learned from the Hillary and Bill health insurance debacle of 1993-1994 is to leave Michelle Obama out of his current drive to get something-anything-through the Congress labeled "reform".
Otherwise, he is making the same mistakes of blurring his proposal, catering to right-wing Democrats and corporatist Republicans, who want an even mushier "reform" scam, and cutting deals with the drug, hospital, and health insurance industries.
His political opponents become bolder with each day as they see his party base in Congress weakening, his polls dropping, and a confused public being saturated with unrebutted propaganda by the insatiable profiteering, subsidized health care giants.
Their campaign-money-greased minions on Capitol Hill and the corporatist Think Tanks and columnists are seizing on President Obama's aversion to conflict and repeated willingness to water down what he will fight for.
The loud and cruel baying pack comes in the form of William Kristol ("This is not time to pull punches. Go for the kill."), Senator Jim DeMint (R-SC) ("If we're able to stop Obama on this, it will be his Waterloo. It will break him."), and Charles Krauthammer yammering wildly about medical malpractice and tort law. Krauthammer does not substantiate his claims or mention the many victims of malpractice as he gleefully predicts "Obamacare sinking."
All these critics have gold-plated health insurance, of course.
Hillary tried to appease the drug and hospital companies. Obama invites them to the White House, where they presumably pledged to give up nearly $300 billion dollars over ten years without any specifics about how this complex assurance can be policed.
No matter, in return Obama and his aides agreed not to press Congress to authorize the federal government to negotiate drug prices with the drug industry. Don't worry: the taxpayers will pay the bill.
At a meeting on July 7 at the White House between drug company executives, Obama's chief of staff, Rahm Emanuel, and Senate Finance Chairman Max Baucus (D-MT), the industry, according to The New York Times, was promised that the final legislative package would not allow the reimportation of cheaper medicines from Canada or other countries even if they meet our drug safety standards.
Since these industry meetings at the White House are private, no one knows how many other concessions were made. What is known is that Barack Obama knows better. A former supporter of single payer health insurance (often described as full Medicare for all with free choice of physician and hospital and the elimination of hundreds of billions of dollars of corporate administrative costs and billing fraud), then-Illinois state senator Barack Obama predicted, in 2003, that it would be enacted once Congress and the White House were controlled by Democrats. Well, that is now the situation, but, as President, he believes single payer is not "practical".
Single payer health insurance is supported by a majority of the American people, majority of physicians and nurses, and nearly ninety members of the House of Representatives. (See H.R. 676 and singlepayeraction.org .)
A clear replacement of the private health insurance companies with federal insurance, as Medicare for the elderly did in 1965, allows for clear language. Twenty thousand people die in America each year because they cannot afford health insurance, according to the Institute of Medicine. Hundreds of thousands more suffer because they have no insurance to treat their diseases or injuries.
Single payer means everyone is covered from birth, as is the case now in every western nation. Imagine no lives lost or suffering due to no health insurance.
Fuzzy proposals, regularly altered and over-complicated due to the hordes of avaricious corporate lobbyists, make politicians like Obama very susceptible to lurid descriptions and lies by his vocal, well-insured opponents. Finally, the Obama people are using "health insurance reform", rather than the misnomer "health care reform" which opened them up to charges that government would take over health care. All proposals, including single payer, are based on private delivery of health care.
Now enters the well-insured libertarian Cato Institute with full-page ads in the Washington Post and The New York Times charging Obama with pursuing government-run health care. A picture of Uncle Sam pointing under the headline "Your New Doctor." Nonsense. The well-insured people at Cato should know better than to declare that this "government takeover" would "reduce health care quality."
About 100,000 lives are lost from medical-hospital negligence per year, according to the Harvard School of Public Health. This vast tragedy is hardly going to get worse under universal government health insurance that assembles data patterns to reduce waste, enhances quality, and transparency. By contrast, the secretive big health insurers who make more money the more they deny claims, ignore their loss prevention duties.
In 1950, when President Truman sent a universal health insurance bill to Congress, the American Medical Association (AMA) launched what was then a massive counterattack. The AMA claimed that government health insurance would lead to rationing of health care, higher prices, diminished choices and more bureaucracy. The AMA beat both Truman and the unions that were backing the legislation, using the phrase "socialized medicine" to scare the people.
Fifty-nine years later, "corporatized medicine" has produced all these consequences, along with stripping away the medical profession's independence. Today, the irony is that the corporate supremacists are accusing reformers in Washington of what they themselves have produced throughout the country. Rationing, higher prices, less choice, and mounds of paperwork and corporate red tape. Plus, fifty million people without any health insurance at all.
On Thursday, July 30, 2009, there will be a mass rally for a single payer system in Washington, DC. It is time to put what most Americans want on the table. (See www.Healthcare-Now.org for more information.)
Ralph Nader is a consumer advocate, lawyer, and author. His most recent book is The Seventeen Traditions .

Published on Saturday, July 25, 2009 by CommonDreams.org
Obama's Health Care Struggle -- Waterloo or Water Down?
by Bill Moyers & Michael Winship
Push finally came to shove in Washington this week as the battle for health care escalated from scattered sniper fire into all-out combat. If it all seems to be getting more and more confusing, join the club. It's hard to see what's happening through all the gunsmoke.

The Republicans have more than health care reform in their bombsights -- they want a loss for Obama so crushing it will bring the administration to its knees and restore GOP control of Congress after next year's elections. In the words of Republican Senator Jim DeMint, "If we're able to stop Obama on this, it will be his Waterloo. It will break him."

The "Waterloo" of DeMint's metaphor, of course, is not the 1974 ABBA hit but the battle in 1815 that ended Napoleon Bonaparte's rule as Emperor of France -- a humiliating defeat and a turning point in European history. Right-wingers like Glenn Beck see Obama as Napoleon incarnate, a popular emperor who must be stopped.

Here's what Beck said on his television show Monday, July 20: "I'm telling you, this guy is dangerous. He's never lost before. He won't understand... like, 'Who are you to question me?' I mean, this guy is practically an imperial President now. When he starts to lose and people start to question him and push him back against the wall, he's not gonna know how to react."

The Republican strategy is almost identical to the way they turned health care into Waterloo for Bill and Hillary Clinton in 1993. Back then, one of their chief propagandists, William Kristol, urged his party to block any health care plan for fear that Democrats would be seen as "the generous protector of middle class interests." Now he's telling the GOP to "go for the kill... throw the kitchen sink... drive a stake through its heart... We need to start over."

So in lockstep are the Republicans that when strategist Alex Castellanos issued a memo outlining their battle plan, party chairman Michael Steele parroted large sections of it word for word in a speech at Washington's National Press Club. Asked a health care-related question that took him off script, Steele replied, "I don't do policy."

As the Republicans fired away, big business stepped up the attack, too, their lobbying and advertising guns blazing. The Chamber of Commerce, for one, announced a major campaign of rallies and print and Internet ads to crush the White House plan for a competitive public option allowing consumers to choose between a government plan and private health insurance. In key states where members of Congress remain on the fence, the airwaves are vibrating with television commercials aimed at shifting hearts and minds away from any change that might threaten profits.

President Obama rejected the Republicans' Waterloo metaphor and mounted a massive media counteroffensive of his own. But the President has already run into booby traps of his own making and minefields laid by members of his own party, exacerbated when the Congressional Budget Office reported that reform plans, instead of controlling costs, would send the national debt further into the stratosphere.

Meanwhile, supporters who want to scrap the present system for fundamental change are staring glumly though the fog of war at a battlefield in total disarray. They fear that in the White House's desire to get a bill -- any bill -- passed by Congress, it will have been so compromised, so bent to favor the big interests, that it will be less Waterloo than water down, a steady diluting of the change they had hoped for and that America needs.

The big drug companies are already so pleased with what they've been promised that they've brought back Harry and Louise -- the make-believe couple who starred in TV ads that helped torpedo the Clinton health care plan -- but this time they're in favor of reform.

According to the Associated Press, the drug industry's trade group PhRMA (the Pharmaceutical Research and Manufacturers of America) and the drug company Pfizer "reported spending more money than other health care organizations on lobbying in the second quarter of this year" -- $6.2 million from PhRMA, $5.6 million from Pfizer.

"Including its latest report, PhRMA has now spent $13.1 million lobbying so far this year. Pfizer has reported $11.7 million in lobbying expenses for 2009."

This is part of the reason, as Alicia Mundy and Laura Meckler recently wrote in The Wall Street Journal, that "the pharmaceuticals industry, which President Barack Obama promised to 'take on' during his campaign, is winning most of what it wants in the health-care overhaul."

Their story describes "a string of victories" plucked from the Senate Finance Committee by drug company lobbyists, including no cost-cutting steps, no cheaper drugs to be allowed across the border from Canada, and no direct Federal government negotiations with the pharmaceutical companies to lower Medicare drug prices.

And that's not all. The Senate Health Committee is giving the biotech industry monopoly protection against competition from generic drugs for 12 years after they go on the market.

No wonder the cost of reform keeps going up and up and up. Could it be that Harry and Louise are happier because, this time, they're in on the deal?
Bill Moyers is managing editor and Michael Winship is senior writer of the weekly public affairs program Bill Moyers Journal, which airs Friday night on PBS. Check local airtimes or comment at The Moyers Blog at www.pbs.org/moyers . Additional research provided by editorial producer Rebecca Wharton.

How Dennis Kucinich May Save the Health Reform Battle

By Joshua Holland, AlterNet
Posted on July 17, 2009, Printed on July 19, 2009
http://www.alternet.org/bloggers/www.alternet.org/141404/

Editor's note: this originally appeared on AlterNet's blog, PEEK.
No time today for a lengthy analysis of the Tri-Committee health bill. My quick-and-dirty take is this. Those who think the bill is a wonderful progressive victory with a robust public option are wrong, and, on the flip side, the charge that it's a "bailout for the insurance industry" is totally divorced from what the bill would actually do if passed.
It is the most progressive, comprehensive and significant health care legislation to come down the pike since Medicare was passed in 1965. If it were enacted as written, it'd go a long way to solving a lot of our problems (but by no means all) and wouldn't break the bank in the process.
But it also fails some of the basic criteria that most progressives have long said is a red-line that can't be crossed. First and foremost, it doesn't have a public option that can compete with private insurers and result in significant cost savings. 
It has a public plan in which -- as far as the statute goes (it can be expanded in 2015 but there's no mandate to do so) -- only 9-10 million people will be eligible to enroll by 2019. Similarly, the publicly-administered exchanges are projected to cover about 30 million by that year. (These relatively small insurance pools will be able to bargain in concert with Medicare to some degree, so their power will be magnified, but still...)
That greatly limits the potential for cost containment. What it does is bend the curve of projected cost growth downwards, and cover about 2/3 of the uninsured. But we'll still have 3-6 % of the population uninsured and being treated at the ER. And while bending the upward curve down a few notches is a very good thing, it doesn't get us where we want to go -- not when you consider that we pay $2000 upwards of $4,000more for every American than the OECD average each and every  year.
But it's more than just the costs or the people left out. Crucially important is that the public plan won't be big or effective enough to serve as a living example of the kind of large-pool public exchange models federal employees now enjoy. And that means it won't be a back-door to a European-style health care system. This is really key. As I wrote last week about the divide between single-payer advocates and those pushing a public insurance option:
The divide that does exist in progressive circles is tactical, not ideological. Most of those pushing the public option would, if they had their druthers, enact a single-payer system. But they recognize that the two commercial enterprises that have spent the most on political lobbying in recent years are the "disease care" and insurance industries. 
Like single-payer advocates, they believe that a large insurance pool with extensive government regulation and some subsidies afford the greatest potential for (near) universality and cost containment.
And they think that given the choice -- given a demonstration that this approach works better than having a fragmented system of private insurers -- most people will eventually opt into the public plan, and we'll end up achieving something approaching a single-payer system -- although an American-style variation -- through the back door.
Obviously, a public insurance plan for which 10 million are eligible to enroll isn't going to serve as an example of the efficiency that comes with a single-payer type system. And the fact that they designed a pretty good public option for which most of the public will be ineligible to enroll (and that wouldn't have as much potential for cost savings as one would hope) was enough to make me consider opposing it. Howard Dean told me recently that he thought a bill without a robust public option wasn't worth passing, and I agree.
And that's where Kucinich, a supporter of single-payer, comes in. He's trying to save the whole promise of this project.
On Friday, an amendment he authored was added to the House bill that allows states to create their own single-payer systems instead of adopting the federally-run exchange system. The original bill allowed states only to enact their own exchange system -- it was a nod to federalism -- with the proviso that if a state (think a deep red one in the South) refused to adopt the plan, the feds could step in and set it up.
The Kucinich amendment is really key. If it were to survive the legislative sausage-making and be enacted into law, the we might expect a progressive state to take advantage of the opportunity and enact a single-payer system in the coming years. And, if those of us who have been pushing such an arrangement are correct, the result will be greater access and better outcomes at a lower price tag for that state's residents. 
And then we can move from an often ill-informed argument over the Canadian or British systems to a debate in which we can hold up a model in which millions of real Americans see very tangible benefits from an actual single-payer system in action.
Thanks, Dennis! Now let's see what comes out of the Senate.

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