Politics for the People March Column on IVN

Memoir Gives First-Hand Account of the Real Crises on the Southern Border

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Originally posted on IVN
By Cathy Stewart

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Since the New Year, I have been reading a steady diet of memoirs. The genre has captivated me since working with my 93-year-old father to finish his memoir, Hilltop Echoes, about growing up on a farm in rural Massachusetts. His book explores family secrets, the joys of a secret trout fishing spot, the loss of his beloved father, moving off the farm and entering the Marines… all told against the backdrop of the New England countryside.

On the memoir road these last two months, I have met Tara Westover’s EducatedInheritance: A Memoir of Genealogy, Paternity and Love by Dani Shapiro; Michelle Obama’s Becoming; and Deep Creek: Finding Hope in the High Country by Pam Houston. I recommend all four. The fifth memoir is a stand out: The Line Becomes A River by Francisco Cantú.

With the partisan debate about immigration and the wall, I realized I knew little about what our 1,954-mile southern border is like for the people desperately trying to cross it in hopes of a better life, and the agents who patrol it.

Francisco Cantú, a third-generation Mexican American, became a Border Agent after college at the age of 23 and served for four years. His book gives us a nonlinear, at times poetic, account of his experiences — of the desert, the thirst, the desperation of those trying to cross into the US seeking a better life, the roles of the cartels and gangs that prey on people looking for safe passage, and the often dehumanizing tactics of the U.S. Border Patrol.

In an essay in the New York Review of Books, Francisco says, “When I began writing, I knew that the book must be anchored by an exploration of the myriad ways violence becomes normalized along the border.”

The book follows the author’s time as an agent along the border and later as an intelligence officer. Francisco began to suffer from nightmares and frequent teeth grinding, and many second thoughts about his role. As his mother reminds him, “You can’t exist within a system for that long without being implicated, without absorbing its poison.”

The third section of the book tells of Francisco’s friendship (while a graduate student) with José, who travels back to Mexico to visit his dying mother and is captured and arrested as he tries to return. Francisco stands with his friend and José’s family as they go through the process and see their beloved husband and father deported.

In one of the final chapters of the book, José tells Francisco that he will continue to attempt to cross, no matter the risk: “I will do anything to be on the other side. To be honest, I would rather be in prison in the U.S. and see my boys once a week through the glass than to stay here and be separated from my family…”

The Line Becomes A River is a haunting memoir about the people on the border and the desert and the shadows that make it hard for us all to see one another. It’s about much of what is missing in the partisan conversation about immigration and “the wall.” Can we break down the partisan walls enough to let the actual people on the border, both sides of it, inform our conversations?

 

Cathy L. Stewart has been a political activist in the independent movement since the mid-1980s. She is the Vice President for National Development at Independent Voting and the founder and host of Politics for the People.

 

***NEWSFLASH***

The Line Becomes a River will be our next P4P selection.

Our conference call with author Franciso Cantú will by Sunday, June 2nd at 7 pm EST.

Reader’s Forum — Maureen Albanese and Helen Abel

Maureen Albanese

Maureen Albanese

Elizabeth Rosenthal lays out in clear language why our healthcare system got in this sorry state and what we can do to help ourselves get better and cheaper care — but that is not enough.  We must also start electing politicians who will get us to a better healthcare system.  Healthcare should be a right — not a privilege as it is now.  We need to organize our fellow Americans around this issue as we are all but one illness away from homelessness.  This book will be a great conversation starter, but more people need to read it and work together to get the system we deserve.

We can look to France, which has the best healthcare in the world, to help us formulate a better healthcare system.  This healthcare system is not sustainable and until a major overhaul is done America itself will be bankrupt.

Maureen Albanese is an administrative assistant and activist. She lives in Manhattan.

Helen Abel

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I found An American Sickness a provocative look at the health care industry and how big profits have been substituted for humane patient care.  Elisabeth goes into great detail about how this has happened and definitely makes a case for the Canadian or Great Britain models of health care.  She also gives tips on how to find out how your hospital rates nationally, where to get drugs more cheaply, and a host of other information.  A good go-to also if you are dealing with a difficult medical situation.

Helen Abel is a Life performance coach and political activist.

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Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

Reader’s Forum — Susan Massad

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A Review of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

I am a consumer of health care, a practitioner and educator in general internal medicine for over fifty years, and a lifelong advocate for health care reform–single payer, a national health care service, and health care for all.  In college, my sophomore term paper was a history of the AMA’s role in defeating Truman’s proposal for a national health service for America.

Critiques of the American medical system have been with us for decades but more recently, as our system becomes more and more dysfunctional, the level and volume of critique has accelerated. The system is too big, too bureaucratic, user-unfriendly, exploitative, bad for our health, inaccessible, and too costly.  These are some of the recurring themes that one encounters in the explosion of commentary in books, articles, political polls and in my favorites, television shows, such as New Amsterdam, and the Resident, that are chronicling the faults in our system that make it so impenetrable to both consumers and practitioners.

I was an avid reader of this literature until there were just too many articles and books to keep up with. I am grateful that I was introduced to Elisabeth Rosenthal’s An American Sickness through Politics for the People as I might have dismissed it as just another critique that I already knew what it was going to say. Even for the jaded and cynical, Rosenthal grabs your attention. I was totally engaged with the first part of the book, How Health Care Became Big Business. She brings her talents and experience as a doctor, social critic, and journalist to her writing, producing a devastating analysis of how the patient, aka the consumer, is caught in a web of confounding business operations designed to maximally exploit them and their illnesses. The book is filled with clinical vignettes that are case studies in patient exploitation, such as the shell game of adding expensive testing, medical equipment and ancillary services to the hospital bill, the charging for the extra anesthesiologist, the moving of procedures to ancillary sites where extra facility fees can be collected as providers form LLCs to increase profit. It is the patient who is left alone with the financial impact of an unregulated drug market, lack of transparency in anticipating hospital and procedure costs, and an insurance market that simply passes on the costs of this exploitative care to the consumer in the form of higher and higher premiums.

Coming away from the book one is left with a strong sense of outrage, and a much better grasp of the complexities and deceptions of the system. I have been in treatment for breast cancer for over six years and continue to be confounded by my monthly bills that quote the charge for the service as one amount, the amount the plan pays as another and the copay as another inexplicable amount and none of it adds up. Rosenthal gives us some way of understanding how these unfathomable charges have landed on our health care bills.

I was somewhat disappointed in the second half of the book “How you can take it back.”  Rosenthal provides some invaluable tools in the form of apps and sources of information and organizations that support us to become more astute consumers of health care as we shop around for the best hospitals, compare drug prices, and question the charges on our hospital bills. She exhorts us to speak up and push back; something that is not so easy to do as individual operators in a system so big and opaque as ours.

What I found most lacking was some recognition of how politicized our health care system is. The three-trillion-dollar American medical machine did not just happen to become the profit center for insurers, hospitals, doctors, manufacturers, politicians, regulators, charities, banks, real estate, and tech—or any of the many other entities that have no connection to health or health care. Much of this giveaway was accomplished through the compliance of our representatives, who vote on the legislation that has facilitated the turnover of medical care to private industry. Medicare and Medicaid were established in 1965 under Lyndon Johnson, a master of the deal. Steven Brills’s book, America’s Bitter Pill, is the sad story of the making of the Affordable Care Act, a political-mash up of deal-making and trade-offs that is the best that our partisan and divided Congress could offer the American people. I am not critical of Rosenthal for not including an analysis of the politics of health care in America in the book, and I would have liked to have some recognition of what we are being asked to push back against in challenging big business health care. I have learned in my many years as a health care activist that I could not impact the flawed nature of our health care system without engaging in changing the way politics is conducted in our country. Health care reform, like educational reform and other major reforms, is not a single-issue item. It is embedded in everything we do.

Where does one look for hope, a way out of this mass of corruption and deception that health care in the US has become? For me, one has to get out of the system and look elsewhere to a number of grassroots, community-based, and patient-initiated efforts to take control of their own health care.  A few examples of this are: Patient run self help organizations such as SHARE that provide support, education and empowerment to women affected by breast or ovarian cancer; Gilda’s Club, a community organization for people with cancer, their families and friends; Project Open Notes, an international movement advocating change in the way visit notes are managed by providing access to patient and families of their medical records; The Maven Project that is leveraging medical school alumni to connect experienced volunteer physicians with safety net clinics across the US to augment and meet unmet health care needs in underserved and uninsured patient populations; The Beryl Institute, a global community of practice dedicated to improving the patient experience through collaboration and shared knowledge, as well as my own efforts to help patients to self-organize health teams that perform as collective, social units for health and healing that is amplifying the patient’s voice in taking control of their own health care.

In An American Sickness Rosenthal eloquently chronicles how dreadfully sick our health care system is. It made me think about the advice that All Stars Project and East Side Institute founder Fred Newman gave at the Performing the World conference in 2007.  In speaking about the despair and chaos of our world, Newman says, “We have to perform the world again—and we are all involved in this—because this one stinks.”

I take this to mean that if we are going to create our way out of the three-trillion-dollar morass that health care in the US has become, it is we the people who will have to do it.

Susan Massad is a retired primary care physician educator who is on the faculty of the East Side Institute where she leads workshops/conversations exploring what it means for people to grow and develop in the face of serious illness, aging or memory loss. Susan is a long time independent activist with Independent Voting.  

 

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Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

Reader’s Forum — Steve Richardson

We Need a Game-Changer

boston 0614If there is any issue that should unite our divided nation, it’s health care.  Mortality limits every one of us; even those blessed with good genes and good habits are one accident away from dependency.  And we all have relationships that change quickly – or cease to exist – if either party is seriously ill.  Most of us spend an enormous amount of money on health insurance – or earn what our employer pays for it.  Instead of appealing to our interest, the industry and our own Congress have taken advantage of us.

Dr. Rosenthal pulls no punches in applying her medical knowledge and journalism experience to exposing the collusion among health care providers, insurers, and politicians that has us in such an unenviable financial and moral predicament.  As an economist, I was impressed with her “Economic Rules of the Dysfunctional Medical Market,” which are carefully linked to examples that I could easily relate to as a consumer.  And I especially appreciated her documentation in Part I of how we got here (“The Age of”  Insurance, Hospitals, Physicians, Pharmaceuticals, etc.).  What comes across quite clearly is that it is indeed a systemic problem.  As she notes in the Introduction, the rules that govern delivery of health care in the US are no accident, and it’s up to us to change those rules.

Of course, we’re a few Davids taking on many Goliaths.  So in Part II, Dr. Rosenthal provides thoughtful measures for personal and political action to incrementally address the dysfunctional relationships we have with insurance companies and providers.  Each is worth considering and sure to benefit some of us, and taken together, they are a good start toward reform.  However, I don’t think we’ll see real change unless we amputate the “invisible hand” on the till that she refers to in the Introduction.  The Affordable Care Act was stillborn because the health care industry made sure it posed no real threat to their market power.  In my view, we will never win control of our own health care by working within a system designed and controlled by special interests.  We need something radical like single-payer, but I would prefer something that restores a free market – like eliminating tax deduction of health insurance premiums by employers and making all health care expenses (premiums and out-of-pocket) deductible for individuals.  That’s not a new idea and it’s not the only solution, but it would be a game-changer.

Steve Richardson is a founding member of the Virginia Independent Voters Association and serves on IndependentVoting.org’s national Election Reform Committee.

***

Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

Reader’s Forum —Cynthia Carpathios

An American Sickness: The Commodification of Americans

“Unless you’re part of the 1 percent, you’re only ever one unlucky step away from medical financial disaster.”

Although most of us are aware that the healthcare system in America is not well, we may not have realized the extent of the illness.  If you are fortunate enough to have a job with decent insurance, you may not realize how vulnerable you really are.

Elisabeth Rosenthal’s book, An American Sickness: How Healthcare Become Big Business and How You Can Take It Back, is a History and Physical of American Healthcare.  It is compelling, sometimes funny, and absolutely appalling.

The Chief Complaint is “hugely expensive medical care that doesn’t deliver quality results.”  Rosenthal then lays out the History of the Present Illness and Review of Systems, a look at how American medicine has transformed from one based on caring to one based on profit. And in the Diagnosis and Treatment, she gives us resources for ourselves and for the broader good, what we can do to be less vulnerable to outrageous doctor bills, hospital bills, insurance costs and what kinds of systemic changes we need to demand from our lawmakers, insurance companies, providers and healthcare institutions, hospital and insurance regulators.

What is so shocking is how vulnerable we all are, even those of us with the best insurance.  All we need is a hospitalization or emergency situation in which, without choice or informed consent, we receive service from out-of-network providers or end up in an out-of-network facility and we can be on the line for astronomical charges.  The provider may just say hello to you at your bedside in the hospital. You may be taken to the nearest facility when you are in a situation where every minute counts, and you may not even be conscious. And the rest of your life you may be in financial ruin.

Increasingly certain groups of providers and certain facilities don’t sign up in networks at all and charge whatever they want.

And this is only one outrageous way to go deeply into debt to our broken medical system.

The breakdown in relationship between the medical industry and the people they serve is one that touches all of us, and I feel particularly close to it. My father was a thoracic surgeon in the “golden age” of medicine.  He accepted what people could pay. We had several beautiful oil paintings from one of his patients. One of my brothers is a physician employed by a large medical conglomerate, who has considered repeatedly whether he can bear to stay in medicine. The differences between my father’s and my brother’s experience of the medical field are enormous.

I work in a hospital, a community hospital that has recently been acquired by a larger medical entity. I do payroll and accounting for the physician practices that are under the hospital’s wing.  I see the bankruptcy paperwork coming in for patients who have gone underwater. I see what we pay for consultants, for drugs, the closing of departments that don’t bring in enough money (we no longer deliver babies at this hospital) and the struggle our little hospital has had to stay open. I see the doctors who experience that despite their big paychecks, they are stressed and unhappy, many of them feeling like drivers being pushed to go ever faster and do more in a system whose focus is on the mighty dollar.

It is riveting and distressing to read Rosenthal’s history of the moves that have been made that have been part of creating the current state of affairs where patients are no longer related to on a human level – where they have become a commodity, a dollar figure.

The medical industry is not alone in this regard.  We have seen similar breakdowns in higher education, in banking and investor relations, in the relationship of employers to their workers, in government and its representatives to the people they are mandated to represent.  Things have never been perfect, there have always been ways in which certain groups have been more privileged; this is embedded in our country’s history. But what we are now seeing is a wholesale breakdown of the relationship between the service industries and the people they are purporting to serve.

What we are seeing is something that can’t just be changed by laws or more regulation.  The creativity of those at the top of the money-making pile to work around issues is enormous.  Yes, those changes are needed, and we need to support them. And we need cultural/social/human development at the same time, without which anything else will never be fully successful.  

Despite the infuriating advantage being taken by those who have the power and money to do so, they are also victims of this system.  Their humanity has been eroded and their growth as human beings stunted. We need to support functional changes where we can do so and we need to bring growth and development into our lives and those around us, transforming the systems that underlie our medical system, our society, our economy, our political system, our country from the inside out. 

Cynthia Carpathios is a long-time political independent and a novice Buddhist monk.  She lives in Alliance, Ohio.

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Rick Robol and Cynthia Carpathios of Independent Ohio

*Reminder*

Conference Call with Elisabeth Rosenthal

Author of American Sickness

Sunday, December 2nd at 7 pm EST

Call: 641-715-3605
Pass code: 767775#

Politics for the People November Column on IVN

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A Review of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back 

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by Kayla Shifter 

Elisabeth Rosenthal accomplishes the seemingly impossible: she’s created a digestible and oftentimes heartfelt guide to the American health care system. Statistical analyses, facts, and financial data litter the book, but with Rosenthal’s ability to seamlessly weave personal accounts and her sharply written “Economic Rules of the Dysfunctional Medical Market” throughout the book, readers can feel emotionally invested in the political football that is our country’s health system.

Health care is often treated as a partisan issue, but so clearly transcends politics: everyone needs it. Rosenthal—a doctor and editor-in-chief of Kaiser Health News—comes at our flawed system as someone in the fold and speaks from experience.

Tackling issues like insurance availability, prescription and testing costs, medical billing, and the hospital industry, An American Sickness provides basic understandings with the help of stories from real individuals. These personal tales are injected thoughtfully, with intent. There’s no room for the interpretation on the reader’s part. No one will side with the hospital in Seattle that charged a woman’s insurance company more money for her less-than-a-day of services to remove a dangerous ectopic pregnancy than her two-day stay after her C-section years prior.

An American Sickness Book Cover (1)

In the chapter titled “The Age of Pharmaceuticals”, we learn of the corruption surrounding skyrocketing drug prices. Years ago, generic anti-nausea drugs became difficult to get. Allegedly, someone had purchased the plant that produced the drugs and shut it down. The FDA then issued a warning that linked the generic anti-nausea drugs to dangerous arrhythmias.

When doctors pushed for a Freedom of Information Act to study the documents that pressed the FDA toward its decision, they discovered that the abnormal heart rhythms occurred when doses from 50 to 100 times those typically given in the U.S. were used. The same problems arose when those doses of newer anti-nausea drugs were given, but since the older drugs had been issued the warning, hospital risk managers shied away from purchasing the generic brands. What formerly cost $2 to $3 skyrocketed to $149.

Rosenthal peppers her rules throughout, bringing us out of the misery that our health system can invoke and reminding us that this is not simply a series of recollections or stats, but a guide on how to not allow these circumstances to happen to you. She wants to arm you with the tools to navigate our greedy health industry, to get only the necessary treatments, to avoid surplus charges, and to steer clear of detrimental financial burdens.

Knowledgeable and sharp, An American Sickness is truly a user-friendly guideline for the average person. No one wants to prepare for the worst, but Rosenthal’s book is more punchy than dense, making her tactics and advice memorable. Remember: “Hospitals and doctors get away with unconscionable prices and practices because they think patients will be too timid to call them out on their greed, but they are very sensitive to bad publicity, to being exposed, or to the prospect of losing the confidence and support of a big local employer.”

With this book, Rosenthal gives you the power to fight.

Photo on 9-8-18 at 1.24 PM #3Kayla Shifter is an administrative assistant at Independent Voting, a writer, and an artist. This review was originally published on The Independent Voter Network here

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Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

An American Sickness New York Times Review

 

Why an Open Market Won’t Repair American Health Care

CreditPing Zhu

 

AN AMERICAN SICKNESS 
How Healthcare Became Big Business and How You Can Take It Back 
By Elisabeth Rosenthal 
406 pp. Penguin Press. $28.

A few years back, the future of American health policy appeared to hinge on how similar medical care was to broccoli. It was March 2012, and the Affordable Care Act (a.k.a. Obamacare) was before the Supreme Court. Justice Antonin Scalia zeroed in on its controversial requirement that all Americans purchase health insurance. Yes, everybody needs health care, Scalia conceded, but everybody needs food too. If the government could make people buy insurance, why couldn’t it “make people buy broccoli”?

The Affordable Care Act survived, of course — though not before a fractured court made the expansion of Medicaid optional, leaving millions of poorer Americans without its promised benefits. But the question Justice Scalia asked remains at the heart of a debate that has only intensified since: Why is health care different? Why does it create so much more anxiety and expense, heartache and hardship, than does buying broccoli — or cars or computers or the countless other things Americans routinely purchase each day?

For those leading the charge to roll back the 2010 law, the question has a one-word answer: government. President Trump’s point man on health policy, the former congressman (and ultrawealthy orthopedic surgeon) Tom Price, has said that “nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare.” Senator Rand Paul (another surgeon) and House Speaker Paul Ryan have claimed that the affordability of Lasik eye surgery — generally not covered by health insurance — shows that a much freer health care market would be much less expensive. Their idea of “reform” is to cut back public and private insurance so consumers have “more skin in the game” and thus shop more wisely.

Elisabeth Rosenthal
Credit Nina Subin

The physician-turned-journalist Elisabeth Rosenthal offers a very different answer in her eye-opening “An American Sickness.” Rosenthal — formerly a reporter for The New York Times, now the editor in chief of the nonprofit Kaiser Health News — is best known for a prizewinning series of articles, “Paying Till It Hurts.” In them, Rosenthal chronicled the seemingly endless pathologies of America’s medical-industrial complex, from prescription drugs that grew more costly as they became more dated to hip-replacement surgery so expensive it was cheaper for a patient to fly to a hospital in Belgium.

Rosenthal thinks the health care market is different, and she sums up these differences as the “economic rules of the dysfunctional medical market.” There are 10 — some obvious (No. 9: “There’s money to be made in billing for anything and everything”); some humorous (No. 2: “A lifetime of treatment is preferable to a cure”) — but No. 10 is the big one: “Prices will rise to whatever the market will bear.” To Rosenthal, that’s the answer to Scalia’s question. The health care market doesn’t work like other markets because “what the market will bear” is vastly greater than what a well-functioning market should bear. As Rosenthal describes American health care, it’s not really a market; it’s more like a protection racket — tolerated only because so many different institutions are chipping in to cover the extortionary bill and because, ultimately, it’s our lives that are on the line.

Consider the epicenter of America’s cost crisis: the once humble hospital. Thanks in part to hit TV shows, we think of hospitals as public-spirited pillars of local communities. Yet while most are legally classified as nonprofits, they are also very big businesses, maximizing surpluses that can be plowed into rising salaries and relentless expansion even when they are not earning profits or remunerating shareholders. And they have grown much bigger and more businesslike over time.

Rosenthal tells the story of Providence Portland Medical Center, a Northwest hospital system founded by nuns. Four decades ago, its operational hub in Portland, Ore., consisted of two modest hospitals: Providence and St. Vincent. As it happens, my mother was a nurse at St. Vincent for more than half those years, and thus had a front-row seat as Providence transformed from a Catholic charity into one of the nation’s largest nonprofit hospital systems, with annual revenues of $14 billion in 2015.

Along the way, Providence jettisoned most of its original mission, replacing nuns with number crunchers. Once run mainly by doctors, it filled its growing bureaucracy with professional coders capable of gaming insurance-reimbursement rules to extract maximum revenue. Meanwhile, Providence stopped paying doctors as staff and reclassified them as independent contractors (though not so independent they could skip a “charm school” designed by its marketers). Yet even as its C.E.O. earned more than $4 million, Providence touted itself as a “not-for-profit Catholic health care ministry” upholding the “tradition of caring” started by the nuns (now listed as “sponsors” in promotional materials). Rosenthal sums up the result as “a weird mix of Mother Teresa and Goldman Sachs.”

Actually, not much of Mother Teresa: Providence-like consolidation in every part of American health care has created a structure at least as concentrated as the European systems conservatives decry, yet without the economy or coordination of care such concentration might offer if it were focused on people rather than profits. The Yale economist Zack Cooper has shown that prices paid by private insurers are not just massively higher than those paid by Medicare. (They’re in a different orbit from those paid abroad.) They are also hugely variable from place to place and even institution to institution, without any evidence that higher prices produce better care. Providers charge high prices not when and where they need to; but when and where — courtesy of consolidation — they can.

Rosenthal’s book doesn’t conclude with conglomerates. She also provides an eye-opening discussion of skyrocketing drug prices, as well as the less-familiar pathologies of excessive medical testing and overpriced medical devices, such as artificial hips and knees — a market dominated by a few manufacturers that, like big drug companies, shun direct competition in favor of building cozy relationships with the people who prescribe their products. In each case, Rosenthal diagnoses the incentives of the system by recalling the professional advice of Willie Sutton, who said he robbed banks because “that’s where the money is.” What outsiders might see as inefficiency or a conflict of interest, she shows, insiders have carefully constructed to maximize their bottom line. She also weaves in moving tales of those who are paying dearly for that enhanced bottom line — which, in the end, includes all of us.

Where Rosenthal’s account falls short is in explaining why this deeply broken system persists. Early on, Rosenthal seems to side with Speaker Ryan and Senator Paul, describing “the very idea of health insurance” as “in some ways the original sin that catalyzed the evolution of today’s medical-industrial complex.” But, as Rosenthal (too briefly) discusses, countries where people are much better insured don’t have anything like our self-dealing, upside-down incentives and outrageous costs. Somehow, despite largely keeping citizens’ skin out of the game, other rich democracies manage to have much lower costs per person — as well as greater utilization of physician and hospital services and better basic health measures.

The fact is that people need insurance for the highest costs they face. They may be able to pay for Lasik, a nonessential, nonemergency procedure for which consumers have plenty of time to shop around. But the biggest-ticket items — cancer care, cardiac surgery, organ transplants — are beyond the reach of all but the richest, and not so easy to shop around for when they’re needed. Just as we shouldn’t blame the idea of mortgages for the financial crisis, we shouldn’t blame the idea of health insurance for the health care crisis.

The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. In every country where people have access to sophisticated medical care, they must rely heavily on the clinical expertise of providers and the financial protections of insurance, which, in turn, creates the opportunity for runaway costs. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge.

 

In the United States, such counterpressure has been headed off again and again. The industry and its elected allies have happily supported giveaways to the medical sector. But anything more, they insist, will kill the market. Although this claim is in conflict with the evidence, it is consistent with the goal of maximum rewards to (and donations from) the industry. As a result, Medicare beneficiaries have prescription drug coverage (passed by Republicans in 2003), but Medicare administrators have no ability to do what every other rich country does: negotiate lower drug prices. In January, President Trump said drug companies were “getting away with murder” because they had “a lot of lobbyists and a lot of power,” insisting he would get Medicare to bargain. Should we really be surprised that the dealmaker in chief dropped the subject after meeting with pharma executives earlier this year?

Without a clear view of the political economy of health care, it’s easy to see the problem as Justice Scalia did. If we could just start treating health care like broccoli, the market would solve the problem. But as Rosenthal’s important book makes clear, the health care market really is different. Speaking of her Times series in 2014, Rosenthal told an interviewer her goal was to “start a very loud conversation” that will be “difficult politically to ignore.” We need such a conversation — not just about how the market fails, but about how we can change the political realities that stand in the way of fixing it.

Jacob S. Hacker, a co-author of “American Amnesia: How the War on Government Led Us to Forget What Made America Prosper,” is the Stanley B. Resor professor of political science at Yale.
Original content at New York Times American Sickness Book Review

New P4P Selection: An American Sickness

P4P_bookclub_flyer_Rosenthal

Mary Bowser’s Secrets Are Ours

A Review by Frank Fear

Reading engages you. You start and stop, reflect, make notes, ponder, and visualize, interacting with the text all the while, slowly and progressively.

That experience intensifies when reading historical fiction. You imagine what it was like “back then,” speculate what you might have done, and ponder what the story means in contemporary terms.

Historical transposition was my specialty while reading The Secrets of Mary Bowser. The academic in me enjoyed learning about an important historical figure. But vocation, I soon found, was trumped by something more powerful.

I’ve known hundreds of ‘Mary Bowser’s’ in my life. None of them was as bold in character or as important in history, but they did important things, still.  

Some ‘Mary Bowsers’ turned their backs on privileged positions with institutional accouterments. Others fought from within—as Mary did—as ‘guerillas of the bureaucracy.’

All of them jettisoned chains that had once entrapped them. They stopped playing the role of ‘made-up self’—a self that ‘assumed the position’ and parroted ‘the party line.’ And they all experienced that’ moment: “Enough!” “No more!”

Mary’s ‘secrets’ are theirs, too—and ours—in a collective sense. That’s because social activists share much in common, irrespective of time, place, or issue.

Reaching that conclusion made it possible to align Mary’s story (see text quotes that follow) with stories I’ve heard over the years.

*****************

At the start, Mary and others thought their evolution wouldn’t be difficult.

“I been a slave wishing for freedom my whole life. Being a free woman play-acting as Secrets of Mary Bowser Bk Coverslavery can’t be harder than that.” (p. 48)

But they soon found it wasn’t easy—even after discovering they had companions on this new journey.

“I knew Miss Bet was playing a necessary part in front of our fellow passengers, that she was reminding me of the need for me to play my part as well. But her words stung me hard. As we took our seats, my head hung heavy with loneliness.” (p. 55)

Life quickly turned on its head.

“All my childhood, we in the house were allied in constant conspiracy with Miss Bet. I learned from watching Mama and the rest to smile and nod at her, but then roll eyes and mimic her words once her back was turned…. Now here I was in the North, and about the first thing I had to do was defend her, and to a colored woman.” (p. 66)

It was easy to be angry at this, angry at that, and—especially—angry at self.

“I was angry at that weasel-faced woman for sending me back to that bench, angry at the Quakers for having such a bench at all, angry at the elderly colored man for sitting on that bench for five decades or more…. But I was most angry at myself, for forgetting what Mama and Papa taught me, the thing that guided every moment of my life in Richmond…. I berated myself for not remembering their most important lesson.” (p. 116)

It would have been SO much easier if the targets of angst were always up to no-good. They weren’t, though. They were flawed, though. They’d talk about the real world as if they really knew something about it. But what they offered came mostly from privilege, not practice.

“The slavery I was born into…was very different.” (p. 126)

So how did Mary and my colleagues respond to hogwash? They learned to parse words carefully, that’s what. Speaking out/acting up less was better than speaking out/acting up more—even when egged on.

(Theodore to Mary)

“Your audacity that evening was quite impressive. I was longing to say something to that lot of pompous fops myself.’” (p. 138)

“They’re as predictable as parrots, repeating the same dull phrase over and over.” (p. 144)

“You are as fresh and unspoiled as the first breeze of spring coming through the window of a house that’s been shut up all winter.” (p. 148)

Political viability required cultivating the art of ‘picking one’s spots.’

Yes, the old life was easier. This new life, on the other hand, was chock full of unknowns, risks, and dangers.

“The first time I ever saw McNiven, I’d feared what threat he might be, to Mr. Jones and to me. Now because of him, I’d been in the greatest true peril I ever knew—but he’d had as much to do with getting me out of it as with putting me into it.” (p. 179)

Rather than wilt under pressure, though, they drew strength from peril—strength that was apparent in language. Expressed lyrically, their words were uplifting, grounded in values and lathered with principles.

“We hear folks speaking of compromise, and containing slavery, and preserving the Union. But what is to be compromised, contained, or preserved, for the husband who has a wife in slavery, the mother who has a daughter in slavery, the brother or sister, the child a father?” (p. 198)

“John Brown dies this morning. But Dangerfield Newby is already dead. John Brown did a great thing in the name of justice. But Dangerfield Newby did as great a thing in the name of love. John Brown is an exemplar to many in the struggle to end slavery. But Dangerfield Newby is a hero of our own. It is his death we must mourn, must honor, and must be ready to die ourselves, if need be.” (p. 201) 

This new life was about convictions—convictions shared with kindred spirits, including people they never dreamed would become allies.

“When I first met McNiven, I couldn’t have imagined I’d take pride or comfort in knowing he meant for us to ally together. But back then I couldn’t guessed I’d ever connive to travel back across the Mason and Dixon’s line, either.” (p. 213)

Those associates stood tall, always in opposition to others’ backpedaling and intransigence.

“Compromises. Congress would continue carrying on with its compromises…. Decades and decades of them, and every one made to protect slaveholding.” (p. 229)

How inspiring! It confirmed that ‘the cause’ was right, proper, and just.

“The thing that seeps so sweet and warm it makes you feel like every day is the first day of spring.” (p. 241)

Exuberance was necessary, too. The fight wouldn’t end quickly, no ‘sixty-day war’ (p. 284) would it be. Persistence was required, especially when defeat seemed imminent.

What then?

“I wasn’t about to give up so easily. After all, Mama raised me on a steady regimen of stealth and surreption, especially when it came to doing right by those in need.” (p. 266)

“…Mr. Ralph Emerson’s Essays. I had read them years before, in Philadelphia…. Mr. Emerson’s theme of following one’s moral purpose rather than succumbing to the weight of social convention was inspirational.” (p. 268).

Flowery prose wasn’t enough, though. Skills and capacity were. Getting progressively better at playing one’s role was required to counter “their” ingenuity.

“Sketched on the bottom of the missive was the oddest-looking maritime conveyance I’d ever seen. She had no sails, and most of the hull sat below the squiggly marks meant to show the waterline…. The Virginia was an iron-clad monster of the sea.” (p. 298)

And they did just that.

“A balloon big enough to life men into the air and carry them over the battle lines, so they may observe the Confederate defenses.” (p. 317)

Going to that next level of proficiency often came after a ‘hot button’ was pushed. It fueled anger. The use of duplicitous language was one trigger:

“We do not fight for slavery…. We fight for the right of States to govern themselves.” (p. 311)

Self-serving assertions were another:

“Everything will return to how it was.” (p. 318)

But the worst moments came …

…when they aided what they were fighting against…

“Papa was likely…making bayonet stocks for Confederates to use to impale the very men who were fighting to make him…free.” (p. 334)

…when they recognized that the fight was about many things, not just one…

 “What was smallpox but another form of suffering in a world full of pain and misery? ….Colored or white, the infectious corpses of the smallpox dead met the same ignominious end—the incinerator….” (pp. 343, 346)

…when they realized this fight was unending.

“I realized how vulnerable negroes were, even in their own houses in the North…. Freedom from slavery, maybe, but clearly not freedom from harm.” (pp. 363, 364)

In the face of all that, how far would they go for ‘the cause’? Not as far as you might speculate. Ethics prevail.

“What you describe is a despicable act, and if it occurred as you say, there is no excuse for it. But there is no excuse for us to behave their way, either.” (p. 395)

*****************

Do Independents have a role to play in these dynamics? You bet.

Unencumbered by strictures that otherwise constrain, Independents are society’s best hope for championing ‘the cause,’ that is, serving the public good. There is no higher calling in America’s politics.

Mary understood that.

You do, too.

Many others will.

“The past is the present, isn’t it? It’s the future, too.” Eugene O’Neill

(Cited by L. Leveen, Reader’s Guide, #12, The Secrets of Mary Bowser)

 

frank-fear

Frank A. Fear is professor emeritus, Michigan State University, where he served as a faculty member for thirty-year years and worked in various administrative positions for nearly twenty years. Find him on Twitter @frankfear and on Tumblr, “For the Public Good”.  Frank also writes about issues that intersect sport and society. You can read him at The Sports Column.

***

Politics for the People

Conference Call

With Author Lois Leveen

Sunday, June 3rd at 7 pm EST.

Join us and Explore

The Secrets of Mary Bowser

 ***

Politics for the People May Column on IVN

Below is my Politics for the People column from IVN this month.  It includes Caroline Donnola’s review of The Secrets of Mary Bowser.  Then join us as we read Lois Leveen’s wonderful historical novel.  Our conference call with Lois will be on Sunday, June 3rd at 7 pm EST.

Politics for the People Book Club: The Secrets of Mary Bowser

Editor’s note: this article was co-authored by Cathy Stewart (introduction) and Caroline Donnola (main article).

The Politics for the People (P4P) Book Club brings together independent-minded Americans to read a wide range of books—both fiction and non-fiction—of interest to independents.  With each selection, we have a lively dialogue on the P4P blog culminating in an hour conference call conversation with our author.

We just finished reading Greg Orman’s book, A Declaration of Independents: How We Can Break the Two-Party Stranglehold and Restore the American Dream. On Sunday, April 15th we spent an hour with Greg talking about his current independent campaign for Governor of Kansas; the lessons he learned in his independent run for US Senate in 2014, and much more.

You can listen to our conversation on the blog.

Our next selection is the historical novel, The Secrets of Mary Bowser by Lois Leveen.  I am a fan of historical fiction. It can free us up to actually gain a deeper understanding of a particular moment in time, the leaders, the lives and the actions of ordinary people that shape history.

This book was recommended by P4P member Caroline Donnola, and I asked her to write the review below.  You can visit the blog, read along and join us on Sunday, June 3rd  at 7 pm EST when we will be talking with author Lois Leveen.

politics for the people

 

I’ve always loved to read, and then I majored in literature and writing. A lifelong fan of history, I often gravitate toward historical fiction as it combines these two great loves. Every day, on my commute from Brooklyn to Manhattan, I travel with my well-stocked Kindle. When I discovered The Secrets of Mary Bowser by Lois Leveen, I knew I wanted to share it with members of the Politics for the People Book Club.

The story is an intriguing one. As a young girl, Mary, a Virginia slave, is freed by Bet, the daughter of her master who sends Mary to Philadelphia to be educated. There Mary lives as a free Black woman and becomes active in the Underground Railroad. She builds a new life for herself.

But when Mary’s mother dies and her father becomes ill, she returns to Richmond where she must live, once again, as a slave. When she sees the chance to continue her fight for freedom for all slaves, she becomes a servant in Confederate President Jefferson Davis’ household where she spies on him and reports her findings to Union commanders.

Based on a true story and a real heroine, most of us have never heard of Mary Bowser. And because so little is known about her, the author is forced to imagine how Mary would think, speak and act as a child, in addition to as an educated woman and as a spy who must speak and act like a slave to conceal her identity.

Leveen creates Mary’s world and populates it with real and imagined historical figures in the years before and during the Civil War. We see, hear and feel Mary’s world of loving parents who are determined for Mary to have a better life.

We meet Elizabeth (Bet) Van Lew, the real-life daughter of Mary’s slaveholder who becomes an abolitionist, and upon her father’s death, frees all of her family’s slaves. But Bet cannot free Mary’s father who is owned by another family, and Mary’s mother will not leave without him. We feel Mary’s conflicts as she moves to Philadelphia to live as a free woman but has to leave her parents behind.

During her years in Philadelphia, Mary gets to know ordinary and extraordinary fellow travelers—free Blacks, Quakers and other abolitionists. She learns which parts of town she cannot enter and she encounters hate-filled white mobs.

We learn about the Philadelphia Female Anti-Slavery Society and the fights that took place amongst the abolitionists. We hear their arguments about John Brown, and we discover a historic event that took place when the train carrying his dead body passes through Philadelphia on its way to Brown’s burial site. We experience major Civil War battles and turning points. We witness Mary carefully and painstakingly carrying out her work as a Union spy.

I loved how the author was able to get inside Mary’s turbulent thoughts, her fears, her willingness to risk everything. Her relationships with her friends, parents, colleagues, and husband are complex and nuanced. In particular, her relationship with Bet is thorny, but it develops through their joint efforts to end slavery.

Leveen begins the book with two quotes that help shed light on how she thinks about this mix of history and imaginings. From Ralph Waldo Emerson:

“If the whole of history is in one man, it is all to be explained from individual experience… Each new fact in his private experience flashes a light on what great bodies of men have done, and the crises of his life refer to national crises.”

And from African American abolitionist and women’s rights leader Maria Stewart:

“Who shall go forward, and take off the reproach that is cast upon the people of color? Shall it be a woman?”

In The Secrets of Mary Bowser, we go on a journey filled with love, hope, pain, and sorrow. I hope you will relish this journey as I did and join the Politics for the People call with author Lois Leveen on Sunday, June 3rd.

 

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