Politics for the People December Column on IVN

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REVIEW: Jon Meacham’s “The Soul of America” Gives Americans a Much Needed History Lesson

Here’s a passage that brings historians’ public value to life: “The only way to come to understanding is by knowing the history that has shaped us,” writes Jon Meacham in his evocative, The Soul of America (p. 259).
What Meacham asserts is profound. What appears to be new in America’s politics is often anything but. A more likely description, Meacham contends, is that it’s the newest episode of ‘America’s eternal struggle.’
“I’ve wondered why the next generation can’t profit from the generation before,” Meacham quotes a flummoxed Harry Truman. “But they it never does until people get knocked in the head by experience.” (p. 259)
So true: Live it and know it. But let’s wish it were otherwise. If Americans could actually learn from history and practice accordingly—especially now, living as we are, in the Age of Trump—we’d be so much better off as a nation.But they don’t. And that’s what makes this book so important: Meacham tells many Americans ‘what they never knew.’

If history were truly our guide, then each and every time we scream—“Trump! There he goes again! –we’d appreciate what may be the most poignant passage of Meacham’s book: “And yet and yet—there is always an ‘and yet’ in American history.” (p. 103, bolding added)

America’s script, Meacham argues, is a constant yin and yang—of taking two steps forward (sometimes one) and one step back (sometimes two). He describes it as “the war between the ideal and the real, between what’s right and what’s convenient, between the larger good and personal interest” (p. 7).

Each American president engages in that very same struggle. For example, LBJ exerted moral leadership when he signed The Civil Rights Act—knowing full well that he was likely signing over the South to the Republican Party. Richard Nixon showed a very different temperament—and paid a steep price—when he conspired in Watergate.

Then there was Andrew Jackson, the president who took a Hobbesian view of the presidency (that is, every single day is a war). Jackson, whom Meacham describes as “the most contradictory of men,” ”spoke passionately of the needs of the humble members of society…and made the case for a more democratic understanding of power.” But he (also) “massacred Native Americans in combat, executed enemy soldiers, and imposed martial law” (p. 29), while constantly blaming others and expressing self-pity with regularity.

I’ve come to see Woodrow Wilson—once my presidential hero—in that contradictory way, too. Wilson led America during the era of suffrage triumph and argued vociferously for what eventually became the United Nations. But he also squelched free speech through The Sedition Act (1918) and was adamant about keeping African Americans out of government (they don’t have ‘the intelligence,’ he surmised).

Thank goodness we had activists then (as we have today) that got into Wilson’s face and fought him every step of the way. Alice Paul (my new hero) is one example.

But neither Jackson nor Wilson—add Nixon to that list, too—was a one-off. “If we expect trumpets to sound unwavering notes,” Meacham observes, “we will be disappointed. The past tells us that politics is an uneven symphony” (p. 103).

Consider this: for all the great things FDR did for America, keep in mind that he interred Japanese-, German-, and Italian-Americans during WWII. And he wouldn’t support anti-lynching legislation—despite Eleanor’s constant urging—concerned that he’d lose Congressional votes for his New Deal.

Of course, many of us would trade Wilson or FDR for Donald Trump in a heartbeat. Trump—an extreme version of the losing side of what Jon Meacham calls, “the battle for our better angels”—is the reason he wrote this book: “I am writing now,” Meacham scribes, “not because past American presidents have always risen to the occasion but because the incumbent American president so rarely does,” p. 13).

But staying true to the theme of this important book, Meacham doesn’t see Trump as unique. In many ways, he’s a 21st Century version of that damnable 20th Century figure, Senator Joe McCarthy.

It’s a valid comparison, too. “Our fate (as a society) is contingent upon which element—hope or fear—emerges triumphant,” Meacham writes (p. 7). Lincoln and Obama exuded hope. McCarthy and Trump peddled fear. That’s why—to better understand Trump—it’s advisable to learn more about McCarthy.

“He (McCarthy) exploited the privileges of power and prominence without regard to its responsibilities,” Meacham writes. “A freelance performer who grasped what many ordinary Americans feared,” McCarthy knew that “the country feared Communism…and he fed those fears…. A master of false charges, of conspiracy-tinged rhetoric, McCarthy could distract the public, play the press, and change the subject—all while keeping himself at center stage.” (p. 185)

Sound familiar? Well, there’s more. Even after McCarthy was disgraced publicly, polls showed that 34% of Americans still supported him (p. 201). And McCarthy’s primary advisor—Roy Cohn—later advised a young, New York real estate developer … named Donald Trump (p. 206).

What does Meacham’s work mean for independents? For an answer, I recommend reading the book’s conclusion, “The First Duty of an American Citizen” (p. 255-272). In it, he offers a recipe for response—and two of five ingredients speak directly to what it means to be Independent.

Respect facts and deploy reason: Being able to uncover facts, weigh facts, and come to a reasonable conclusion requires cognitive skills and stick-to-itiveness. It also requires the capacity to disassociate claims from claimants, especially claimants who masquerade as Pied Pipers. To do otherwise, Meacham writes, “is to preemptively surrender the capacity of the mind” (p. 268). The take-away message: think independently.

Resist tribalism: “Wisdom generally comes from a free exchange of ideas, and there can be no free exchange of ideas if everybody on your side already agrees with one another,” Meacham observes (p. 268). Put another way, ‘following the party line’ has costs—not only in terms of constraining the idea pool, but by infecting the public domain with (what I call) the politics of affiliation. To wit: you must go along to get along, especially if you want to get ahead in the party. The take-away message: act independently.

The bottom line is that Jon Meacham’s book is an important read—especially today. Yes, today is probably another chapter in what Meacham calls our ‘eternal struggle,’ but it’s an especially ornery one. To address it effectively, we must learn from the past. But that’s no small order in a society where a lot of folks don’t read much or at all; don’t engage in multifaceted political dialogue much or at all; and get a good share of their news (if not all of it) from friends, social media, and 24-hour ‘news’ networks.

Sadly, there isn’t a lot of depth, understanding, and perceptivity across America today. That makes it easy for the public to be duped, and duping opened the door for Donald Trump.

But duping doesn’t serve democracy—not the kind the Founding Fathers had in mind; not the kind you embrace; and not the kind America needs to be that “Shining City on the Hill” Reagan referenced during his valedictory (1989).

It would be a mistake, though, to conclude that the character of our nation rests solely—even primarily—on the back of the person in The White House. Meacham, among others (Ralph Waldo Emerson, too), believes that it rests with the character of the people (p. 40).

Character. Leading for the public good.

The time is now. The stakes are high. There aren’t alternatives, Eternal Struggle or not.

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Reader’s Forum — Lou Hinman and Jeff Aron

Lou Hinman 

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The runaway inflation in the cost of living in America is worst in precisely those sectors of the economy that the 99% can’t live without — higher education, housing, and healthcare. In An American Sickness, Dr. Elisabeth Rosenthal describes in excruciating detail how American healthcare has been hijacked.

How did this happen?  How did we Americans get so divided that a plastic surgeon dares to bill $50,000 for 3 stitches – just one of the many examples that Dr. Rosenthal sites.  (I also read a story not long ago in the New York Times about an “out-of-network” surgeon who ambushed an unsuspecting patient, sewing him up after his operation, and then billing him for a quarter of a million dollars!)

Medicare has become a vast, publicly owned resource  – a huge accumulation of money, automatically withheld from the paychecks of working people for their entire working lives – that is ripe for systematic looting by private interests.  In exactly the same way, private insurance companies don’t complain about extortion by the drug companies, and the newly privatized “not-for-profit” hospitals and their incorporated medical practices, because they can pass the extortionate billing on to their tens of millions of subscribers – you and me.

The corruption of the American system of healthcare has become institutionalized.  Indeed, our healthcare system now fits Irving Goffman’s description of a “total institution” – an institution that, whatever its original or nominal purpose, has as it’s real priority perpetuating itself and benefiting its hangers-on.  Such total institutions are, as Dr. Rosenthal suggests, a sign of a culture in decline.

When President Eisenhower left office in 1961, he warned us about what he called the “military-industrial complex.” In the decades that followed, military production did, in fact, become a juggernaut of profit-making for private interests and, simultaneously, an institutionalized parasite on the productive resources of the American economy and the needs of the American people.  Healthcare in America has now become just such a parasite – the “medical-industrial complex!”

As Dr. Rosenthal astutely observes: “In healthcare, entrepreneurship outsmarts regulation every time.” In the independent political movement, we know this pattern very well.  We’ve learned, for example, that trying to stop the flow of money to Democrat and Republican politicians by campaign finance reform can’t succeed, because new regulations, written by those politicians, come with new loopholes.  The development of new corrupt practices is impossible to keep up with, in both politics and in healthcare, without addressing the question of political power.  We can’t reclaim either our government or our healthcare without creating a new political culture.

Lou Hinman lives in New York City and is an activist with IndependentVoting.org and the New York City Independence Clubs.

Jeff Aron

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I won’t say that I “enjoyed” reading An American Sickness by Dr. Elizabeth Rosenthal. It corresponded too closely to experiences of my family and friends – not merely the illnesses and deaths but the difficult engagements with all aspects of a system that creates economic and existential insecurity which have nothing to do with “health.”

Whether based on personal interviews or other research, the stories Dr. Rosenthal shares help us to understand and are devastating critiques of the (mis)organization of healthcare in the United States. So many people are failed by this “system”. I kept wondering what those who supported it might say in its defense. More to the point, I wondered what we as a country would need to do to produce a system(s) other than what we have. What can we do about the overweening power of hospitals, insurance companies, and pharmaceuticals — all of which have enormous political leverage as well as economic incentive to keep things as they are? Would it be possible to build partnerships between those who currently profit from this state of affairs and those who are not served well by it? How might that be organized?

I really appreciated Dr. Rosenthal’s suggestions about what individuals can do. However, I feel similarly to Susan Massad and others who have written that something bolder — more grassroots and more challenging of the larger system of which healthcare is a part — needs to be undertaken.

As I read An American Sickness, from my location as an activist in the mental health arena who also has been a community organizer, I thought of areas of concern and contention in healthcare which might have been more fully explored, e.g., severe mental disorders, aging, and lack of access and education for marginalized groups. While addressing these may not have strengthened the very strong case Rosenthal makes, including these populations as resources would be powerful elements of a movement for change.

I also thought about my brother, my mother, my life partner — all of whom died of serious illnesses — the challenges we faced, the diversity of people we met, the pharmaceuticals that were prescribed, the offices, clinics and hospitals we entered — and how all of us were shaped (deformed) by the economic and political forces that organize the practice of medicine — and everything else in our society. We can and must do better.

Jeff Aron has been active in independent political efforts in New York City and nationally since the late ’70s. He is a passionate supporter of IndependentVoting.org


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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 — Dr. Jessie Fields

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Dr. Jessie Fields (center) with Carrie Sackett, Alvaader Frazier, David Belmont and Nardo Reyes –  New York City Independence Club Activists in Harlem doing street outreach.

Health Care Should Be About Health 

I am a community primary care physician. I grew up seeing the effects of social isolation and poverty in the black community and I became a doctor because I wanted to help improve the life conditions of the black poor. Practicing in the poor community, initially on the West Side of Chicago, I soon realized that I had to go outside the walls of the clinic and outside the institution of medicine to be able to work on improving the community’s health.

This lesson is also relevant to the book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal. The book is a revealing analysis of the high costs of for-profit medicine as well as an activist guidebook for the American people and patients to confront and change a system that impacts all people.

Those outside the system in partnership with caring health providers I believe can and are making changes. I look forward to our discussing efforts to change the system when we speak with Elisabeth Rosenthal on the conference call on December 2nd. As Rosenthal states in the last few sentences of the book’s Afterward, “…the crusade to take back our health care system…. it’s going to be a long war.”

She documents how American medicine became the highly expensive, wasteful, inefficient complex business designed to generate profit that it is today. Rosenthal tells the story of the beginning of health insurance with Blue Cross and its partner, Blue Shield, which were nonprofit and accepted everyone who sought to sign up. “The original purpose of health insurance was to mitigate financial disasters brought about by serious illness…” Over the subsequent decades, especially through the 1970s and 1980s, “For-profit insurance companies moved in, unencumbered by the Blues’ charitable mission. They accepted only younger, healthier patients on whom they could make a profit. They charged different rates, depending on factors like age, as they had long done with life insurance. And they produced different levels of protection.”

She outlines all the components of the high cost of medicine: insurance, hospitals, pharmaceuticals, doctors, conglomerates, etc. while also focusing on how high costs impact patients.

“Nearly a third of Americans said they had problems paying medical bills, many among those forced to cut back on food, clothing, or basic household items…But will Congress head their distress call? Or will the powerful business of medicine hold sway, as it has for the past thirty years? Time will tell, but there’s a glimmer of hope on the horizon. But that glimmer comes from you, not from Washington.”

Dr. Rosenthal also discusses the benefits and limitations of the Affordable Care Act. Namely that it has increased access to coverage and care but that in the face of the insurance lobbies and partisan political dysfunction, the ACA did not address the high costs of medicine.

Of course, the high costs of medical care are not limited to the money and financial losses by patients and the larger society. The human costs are even more deeply incalculable. The health and well being of patients and families is undermined.

New approaches to healing that involve human compassion and support are needed but not pursued because the focus is how to make a profit from the latest technology. Expensive technology has replaced the hands-on art of a thorough physical examination.

Departments that do not make money such as Obstetrics, especially in medical clinics that serve poor communities, are closed. Pregnant women have limited access to quality prenatal care, resulting in the United States high infant mortality rate — especially relative to other developed countries. The United States spends more than $3 trillion a year on a health care system that is unequal and unjust. We the people have to change it and I look forward to our conversation with Dr. Rosenthal.

Dr. Jessie Fields is a physician practicing in Harlem, a leader in the New York City Independence Clubs, and a board member of the All Stars Project and Open Primaries.

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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#

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Reader’s Forum — PJ Steiner, Steve Guarin, and Jessica Marta

PJ Steiner

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back was recommended to Politics for the People by PJ Steiner. Read on to see PJ’s response to Elisabeth Rosenthal’s book.  

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I initially heard about An American Sickness by Elisabeth Rosenthal while listening to an NPR interview with Terry Gross. Dr. Rosenthal was incredibly well versed on what the challenges in our healthcare “system” really are and how those challenges came to be. She absolutely wowed me with her excellent communication skills and journalistic chops.

But unfortunately, I became immediately worried about my own, and my children’s, healthcare future. As a Dad of two awesome autistic children, I worry about how they will be cared for throughout their life. I worry even more because our healthcare system (like public education) doesn’t really want to help them as much as it wants to profit from them.

Now that I’ve had a chance to read Dr. Rosenthal’s book, I feel the true immensity of the amoral “healthcare industrial complex” we have in this country. But I also feel some hope. There are a lot of tools and advice to be had to help the regular American fight their way to better care at a more reasonable cost.

Pick this book up. You’ll be glad you did.

PJ Steiner is the Vice President of The Utah League of Independent Voters.

Steve Guarin

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Steve Guarin (r) being presented with a 2016 Anti-Corruption Award by Juliana Francisco

If you want to learn why your wallet is getting lighter and your purse is becoming empty, read An American Sickness by Elisabeth Rosenthal. She lists and explains all the many ways medical care robs your billfold. They will even charge you for things you didn’t use. People have called the billing predatory, which is an outrageous situation to be put in by the people and organizations that are supposed to be helping you.

The subtitle of the story is, “How Health Care Became Big Business and How You Can Take It Back.” In a small part of the book I felt as if she was talking directly at me, the Compliant Patient. Up until I read this book I strived to be a compliant patient. I thought these were the people trying to make me better, but I have learned that is not true. Your family doctor is under a lot of pressure to make use of the expensive facilities of the hospital or medical group that employs him. One type of lab-test which we all get is the simple blood test. It behooves you to ask your doctor to use one of the commercial laboratories, i.e. Quest or LabCorp. It will be exactly the same test but the results from a hospital can be priced one hundred times higher.

Read this book and you will learn how medical care became a rapacious big business. More importantly, the author will teach you to be a Non-Compliant patient, and save some money.

Steve Guarin lives in the Bronx.  He is retired and an activist with the New York City Independence Clubs.

Jessica Marta

Marta

As a health-care provider, I’m familiar with many of the issues that Ms. Rosenthal is talking about in An American Sickness. All the unscrupulous things Ms. Rosenthal mentions, particularly price-fixing by pharmaceutical companies, are happening every day.

Is single payer health-care the solution? I don’t know. The single-payer idea has been around since the ’50s. Back then the American Medical Association shot it down by hiring Ronald Reagan to do TV ads telling the American public that single-payer health-care would take away our Freedom of Choice.

If not single-payer, then why couldn’t the government set limits or standards on the price of drugs or medical procedures? Because our government still caters to powerful special interests.

As long as we live under the current paradigm, that making money is the supreme good, poor people won’t have access to good care and middle-class people who can’t afford to pay for their own health insurance will go bankrupt after paying for long-term treatment. But we just see these as consequences for “others” and hope we are never in those situations.

I feel that patients are not the only casualties of our dysfunctional system. There are many providers who go out of their way for patients, jump through bureaucratic hoops to get care, but these folks can get very weary. I don’t know what the answer is, except a shift in political power on behalf of the interests of ordinary people.

Jessica Marta is an independent activist with Independent Voting and the New York City Independence Clubs. She lives in Manhattan and is an Adult Psychiatric Nurse Practitioner.

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THIS SUNDAY

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 — Al Bell

A Commentary on An American Sickness: How Healthcare Became Big Business and How You Can Take it Back by Elisabeth Rosenthal

DSC_7664My first question to any elected official I contact about health care legislation (and I will) will be: “Have you read Elisabeth Rosenthal’s book, An American Sickness?”

If the answer is yes, my second question will be: “How have her ideas been incorporated in health care legislation you will sponsor or support?” You can probably imagine the course of the ensuing conversation.

If the answer is no, my second question will be: “Why not?” If the answer is, “I haven’t heard of that book,” or any pathetic derivatives of that answer, I will proceed as follows.

“Here is why you should buy it and read it. Elisabeth presents a comprehensive picture of why and how the medical industrial complex in America mistreats patients, the people we used to believe were the beneficiaries of what we used to think of as our health care system. Patients: that is us. She reveals why and how the complex focuses on profit and not health; why it is a cartel and not a system. She goes on to offer advice on how to work around the obstacles to effective health care despite the non-system by providing information on important sources of aid. She closes by explaining what needs to happen to reclaim a responsive health care system from the piranhas that now call the shots. She reminds us that we have a cadre of superb medical professionals, some of whom have become complicit in this disaster, but most of whom ache to carry out their role as healers and menders to those in need.”

“If you are not willing to read it yourself, then assign it to one of your brightest staff members and insist that she/he communicate with Elisabeth before getting back to you with recommendations on how to proceed. Then contact me and let me know what you intend to do, when you intend to do it, and who else you have joined forces with to make it happen. I especially want to know the names of any in the latter category who are not members of your political party.”

While it may be generally agreed that health care has become a major, if not the major, current concern of Americans, it is also self-evident that the medical industrial complex has shanghaied our political world and inoculated it against any conceivable common sense fix. The same force that is necessary to rescue our dysfunctional federal governance miasma from itself is the one that will turn health care around as well: we the people.

We the people need a tool for opening doors, slamming inattention to the floor, and prying open windows to an approach that will actually work. Elisabeth Rosenthal has given us the pry-bar; it is now up to us to wield it.

Elisabeth is not asking the doctors, specialists, technicians, hospitals, pharmacists, pharmaceutical companies, and others to sacrifice reasonable income and profit. She is making the case that extortion in those areas is not legitimate, especially when we pay with not only our money, but our health outcomes as well.

A message to my 60-some active contacts and my elected (some newly) officials in Arizona urging them to read and act on An American Sickness will go out this week.

Oh, one more thing. Thank you, Elisabeth, for the immense public service you have performed in crafting this report to the American people. Bravo, indeed!

Al Bell lives in Peoria, AZ and is an activist with Independent Voters for Arizona.

 

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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#

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

Next Selection–The Secrets of Mary Bowser

Secrets of Mary Bowser Bk Cover

 

Author’s Note

This novel tells the story of a real person, Mary Bowser. Born a slave in Richmond, Virginia, Mary was freed and educated in the North but returned to the South and became a Union spy during the Civil War. Like many ordinary people who choose what is right rather than what is easy, she did extraordinary things.

Few details about Mary Bowser are known today. In the nineteenth century, little effort was made to record the daily lives of most slaves, free blacks, or women of Lois L alternateany race. The scant facts about Mary Bowser that survive cannot tell us what we most want to know: What experiences in freedom would make her risk her life in a war she couldn’t be sure would bring emancipation? How did this educated African American woman feel, subjecting herself to people who regarded her as ignorant and even unhuman? How did living amid the death and destruction of America’s bloodiest war affect her?

The Secrets of Mary Bowser interweaves historical figures, factual events, even actual correspondence and newspaper clippings, with fictional scenes, imagined characters, and invented dialogue, to answer these questions. Like Ralph Waldo Emerson, who lived at the same time as Mary Bowser (and who, in the style of the period, often said man when today we would say person), I believe that the crises of an individual life can shed light on national crises. The novel tells the story of one woman’s life—but it also tells the story of a nation torn apart by slavery, and brought back together by the daily bravery of countless people like Mary Bowser.

—Lois Leveen

 

Lois will be my guest on the Politics for the People conference call on Sunday, June 3rd at 7 pm EST.  So, get your copy of The Secrets of Mary Bowser and start reading today.

Lois also wanted to invite those P4P members who would like an autographed copy of the book to purchase your book from Broadway Books, an independent bookstore in Portland, OR.  You can order your book  and when you are in the check out, there will be a comment section that says: “Use this area for special instructions or questions regarding your order.” You can request an autographed copy or if you would like a more personal message, you can make that request here as well.   

***

POLITICS for the PEOPLE

BOOK CLUB CONFERENCE CALL

With Author Lois Leveen

The Secrets of Mary Bowser

SUNDAY, June 3rd @ 7 PM EST

***

 

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