Health Care Reform : The End of the Beginning

Photo from Circlemp / treehugger.

The end of the beginning:
How ‘historic’ is this reform?

By Dr. Stephen R. Keister / The Rag Blog / March 27, 2010

Health care reform was finally passed by the House and Senate and many consider it an historic occasion. But let’s look at that “historic occasion” and view the legislation objectively. This is primarily health insurance reform and does not produce a sensible program of health care for all citizens on the level to those found in most countries of the civilized world.

We can address that a bit later; however, I am alarmed at the spin-off of a very disruptive right-wing populist movement in the United States, which has emerged out of reaction to the fight for health care reform.

Many of my progressive friends consider this to be a passing phenomenon; however, let us pause for a moment and remember the 9th-10th of November 1938 in Berlin or the 17th Century witch trials in Salem, Massachusetts. Perhaps at my advanced age, with lots of unpleasant memories, I am unduly alarmed; however, more than one social scientist feels that the tea bag movement, which is surreptitiously financed by extremely wealthy members of the financial elite, is of much more concern than many of my liberal friends believe.

I refer all to an article by Chip Berlet, of Political Research Associates, entitled “Right wing ‘populist moment’ could get worse. Message to the Left: stop whining and organize!”

I recall the writings of Eric Hoffer when he noted:

The impression that mass movements, and revolutions in particular, are born of the resolve of the masses to overthrow a corrupt and oppressive tyranny and win for themselves freedom of action, speech and conscience has its origin in the din of words let loose by the intellectual originators of the movement in their skirmishes with the prevailing order. The fact that mass movements as they arise often less individual freedom than the order they supplant, is usually ascribed to the trickery of a power-hungry clique that kidnaps the movement at a critical stage and cheats the masses of the freedom about to dawn.

Coverage on MSNBC last evening was largely dedicated to the proliferation of extreme threats of violence to members of Congress — and their spouses and children — who voted for the health care legislation. Not only are the threats based on misinformation, deceit, and out and out lies, but the foul language being used suggests serious paranoia. It has been estimated that 30% of the population is involved in the right-wing movements; but, considering that the population of the United States is something like 300 million, that’s a lot of crazies.

According to the Erie Times News, my local congressperson, Democrat Kathy Dahlkemper, is receiving extremely frightening messages directed at her and her family. This is a locale where folks line up at the Wal-Mart some mornings waiting for the doors to open so they can buy more ammunition, and where a local gun dealer has problems maintaining his stock in certain types of weapons.

I have disagreements with some of Ms. Dahlkemper’s votes; however, she has given the citizens of her district much more input into matters of national importance than her Republican predecessor did, and she seems much more enlightened in matters of the public good than her likely Republican challengers. In a civilized nation she is deserving of our concern and protection.

I hope that the news media will rise to the occasion and present the news in a fair and honest fashion during the period leading up the elections this coming Autumn, and not give in to the influence of the waves of corporate baksheesh. Meanwhile, it is the responsibility of the Democrats in power to take a cue from the Republican voice machine and do a much better job of getting out the truth to the 70% of the American people who may pay attention to morality and reason

I have had the privilege of following the progress of health care reform on the pages of The Rag Blog for over a year now. This has been an invaluable experience in my final years, and I will forever be grateful to the editor for his forbearance and patience. I would anticipate that my participation will be at irregular intervals in the future, but before I close the current exposition, a few observations:

The current insurance reform legislation in no way resembles a government take over of health care. In fact, as E.J. Dionne of The Washington Post and Commonweal points out, we have a bill that the Republicans could well have passed. It is very similar to the health care legislation that was passed in Massachusetts when Mitt Romney was governor.

There is absolutely nothing in the legislation that resembles a single payer system or even a public option, Medicare for All.

There is nothing in the legislation that approximates the excellent German health system that is, in fact, run by private insurance companies with government oversight of costs and services. Nor is it anything like the Canadian system — for which its driving force, Tommy Douglas, was voted by the people of Canada “the greatest Canadian of all time.”

I notice that health insurance stocks are doing quite well on Wall Street! Unfortunately, in the new legislation there is no effort to control insurance prices or to eliminate the health insurance industry’s anti-trust exemption. I am concerned about the mandatory inclusion of citizens in the plan under threat of fine, and — unlike the Swiss or German plans — it doesn’t at the same time set standards to ensure that the insurance companies provide adequate coverage, and to prevent price-gouging.

I would have wished for less equivocal language regarding the rights of the states to establish honest, effective plans — like that currently proposed in the Commonwealth of Pennsylvania. I would have hoped for the inclusion of community health clinics, as proposed by Sen Bernie Sanders, to be established on the European model. And that the establishment of medical dispensaries be expedited — to address the crowding of emergency rooms and thus reduce the overall cost of medical care, while at the same time providing a reasonable option for follow-up care. These facilities are absolutely necessary considering the fact that the fees paid under Medicaid make it economically impossible for a physician to take many of these folks as ongoing patients and still be able to cover office overhead.

There was some encouraging language in the legislation regarding subsidies for medical education that should result in more physicians for underserved areas; however, this requires much more fine tuning. As has been repeatedly pointed out by the American College of Physicians, much more attention must be directed at the paucity of primary care physicians — general internists, pediatricians, and family physicians — throughout the nation.

This problem is largely due to the inequitable fee schedules for these fields when compared with those in the surgical subspecialists, who are very well rewarded despite spending no more time in training than the internist or pediatrician. This has become a societal problem, largely driven by misinformation on TV that creates the myth that it is only those in the highly publicized specialties who are really in the “life saving” business.

We should express thanks for the collective courage of the orders of Sisters throughout the nation who came out in support of universal health care, especially in the face of pressure from their ecclesiastical “superiors.” We must remember the dedication of the nuns in the areas of healing dating back to the great medieval hospitals they founded during the Middle Ages, including the Hotel-Dieu in Lyons in 542; the Santa Maria della Scala in Siena in 898; St. Bartholomew’s in London in 1123; the Ospedale di Santa Mana degli Innocenti in Florence in 1421; and the Hotel-Dieu in Beaune in 1452.

These Sisters cared for the ill, the infirm, the dying, and the mentally ill without regard to pay or their own well-being as they administered to the dying during the plague. At the same time, the Papacy in Rome, influenced by the Borgia family, was pursuing other less spiritual interests!

In any event we have in hand a bill that according to the AP:

  1. Within 90 days will provide access to high risk pools for people with no insurance because of preexisting conditions. (The politicians like to compare these pools to those provided for the members of Congress, neglecting to say that 80% of their premiums are paid by the government.)
  2. Six months after enactment will bar insurers from denying coverage to children with preexisting conditions; will bar insurers from imposing lifetime caps on coverage; will require insurers to allow children to stay on their parents policies until they turn age 26.
  3. In 2013 will increase the Medicare payroll tax and expand it to cover dividend interest and other unearned income for singles earning more than $200,000 or joint filers making more than $250,000.
  4. In 2014 will provide subsidies for families earning up to 400 percent of the poverty level, currently about $88.000 a year, to purchase health insurance; will require most employers to provide coverage or face penalties; will require most people to obtain coverage or face penalties. (Nowhere, it seems, does the legislation provide assurance that the insurance companies will not triple the rates for those with preexisting conditions.)

We must congratulate the Congress, in a supplement to the health care legislation, for providing student loans directly to the students, and preventing the banking industry from gouging the program as has been the practice in years past.

[Dr. Stephen R. Keister, a regular contributor to The Rag Blog, lives in Erie, PA. He is a retired physician who is active in health care reform.]

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16 Responses to Health Care Reform : The End of the Beginning

  1. Hosea W. McAdoo MD says:

    Dr. Keister, as usual I completely agree. I wish to state my views as to why your concern about the right is correct. I also fear that this is not a passing fad.

    Uneducated, uninformed people are easily manipulated and many of these see violence as the only means of argument because of their intellectual limitations. Why else would they vote in opposition to their own interests and in favor of the ultra rich, backers of the tea party who do dot care for them?

    Progressives tend to be less action and more diplomacy while the radical right uses strong action and violent words to make their, “might makes right” argument.

    When these two are pitted on the two sides it leaves the liberals with a completely uneven playing field. The right won’t listen to reason and the left will not have defense against the violence. This is why I fear for the future. Big money has no plans to stop using the uneducated pawns to do their dirty work and unless liberals stoop to the same level the outcome looks pretty hopeless: a fight between a gun and logic.

  2. Unfortunately, our liberal friends in Washington are wrong to assume that only a small number of voters are swayed by appeals to paranoia. The GOP has learned how to generate rage over longer and longer terms. The future could be grim.

    The Tea Baggers blockaded Dahlkemper in her office and she had to take some risks in escaping.

  3. Richard says:

    Direct action by T-baggers, GREAT. I love it when a movement is new, the crowds are growing, and all the motion is in your favor. There is a lot to come as experienced organizers know, we’ll see how they handle it. This anarchist is always cheering for people against the corrupt evil gubermint, no matter who they are.

  4. Don’t see how you can say that, Richard.

    Would an anarchist root for anti-government forces if they were, say, overtly pro-totalitarian? Doesn’t make sense.

    And what if they were driven by misogynist, racist philosophies — and much of their rhetoric was hateful and mean-spirted? And if they called for violent retaliation — not against the state, but against individuals with whom they simply disagreed.

    And what if they were financed and controlled (at least to a great extent, as is the case here) by rich elements within the ruling class.

    And what if they were not only overtly anti-intellectual but were also fueled by and were championing blatantly and demonstrably inaccurate and dangerous information.

    Throughout history, supposedly populist and anarchistic uprisings have often been inspired, used, and manipulated by forces of the state.

    Isn’t the philosophy of anarchism based in a belief that people can (and should) work together with mutual respect and create associations and institutions that can fulfill their mutual needs outside the structure of a nation state?

    Does the tea party movement reflect the spirit of Joe Hill?

    I really think you are romanticizing here, Richard, and that you personally would find much of this movement — even though many who gravitate to it have good instincts and legitimate grievances — to be ominous, and even frightening.


  5. Thorne must be talking about

  6. Richard says:

    Gosh, those are a lot of what ifs. But I’ll give it a shot. Anarchist, have and do root for and fight for anti-government forces that were and are overtly pro-totalitarian. Although I don’t see the T-baggers as pro-totalitarian. A couple of historical cases in point are the Anarchist forces that supported and fought along with the PLA against the Kuomintang in China in the late 30’s and 40’s. Later their status was reduced and denounced by The Chairman to that of “roving rebel bands.” The Anarchist in all phases of the Cuban Revolution[s] especially Comandante Camilo Cienfuegos’ Third Column and Frank Fernandez, who wrote the history of Anarchist participation in the Cuban struggles from as far back as 1865- The Totalitarian Fidelista government squeezed them out of participation in the government after the victory of 1959. More recently, and a case of which I have some personal knowledge is that of Nicaragua before, during and immediately after the “Contra war.” The Socialist who seized power with the fall of Somoza began to separate themselves from their former “Comrades-in-arms” and kept them at arm’s length. The Anarchist assassination team sent to kill Somoza was denied re-entry to the country after the deed was done. Some of those went to Mexico and at least one who I know was later a member of the Zapatista negotiating body. We live our politics, we stand four-square behind the destruction of State Power, that we have been unsuccessful in making that destruction stick, due to subsequent power grabs by communist, socialist, liberals and monomaniacs should not deter us from the struggle. I in no way support the T-baggers, I don’t even know who they are, (and I suspect that they don’t know who they are.) I don’t have a dog in that fight. However, as a spectator from the sidelines I know that direct-action against an official of the evil beast, beats talking every time. I occupied three nukes, one of them in Texas twice and one in New Hampshire four times and a lot of the success of the A/N movement in stopping nukes came from those direct actions.
    I intend to answer all of your what ifs but I am currently on the move and it will take a day or two.

  7. I read Thornes comment carefully to be sure he wasnt making a sarcastic joke. But he was serious.

    Would an anarchist root for anti-government forces if they were, say, overtly pro-totalitarian? Doesn’t make sense. Your want us to think you are opposed to totalitarian control, while your blog is filled with folks upset that the government didnt eliminate private insurance and take over all healthcare services. That they havent nationalized the banks enough so there would be complete control of the money supply. That they havent gone far enough controlling industries and energy in the name of cimate change. Your comment about opposing totalitarian control is absurd. That exactly the kind of policies what this blog advocates daily.

    Isn’t the philosophy of anarchism based in a belief that people can (and should) work together with mutual respect and create associations and institutions that can fulfill their mutual needs outside the structure of a nation state?
    Nope. That would be my group the Tea Parties. The one that wants to reduce and remove the influence of the federal government. Your group continually advocates policies that enlarge the power of the federal government.

    I havent decided yet if your movement is just completely deluded or if you are just shils for the Democratic party. You cant possibly have any serious affection for anarchy and believe what you espouse.

  8. DHS. Dude. My first question was a THEORETICAL one! I was asking if an anarchist would support ANY opposition to the government, no matter what those opposing it were FOR.

    Look, I believe you often come to bizarre conclusions, DHS, but you think about issues and address them directly and with passion. And I have to assume that you hang around here at least partly because you think we consider important questions and do so with intelligence, even if you mostly disagree with us.

    But here’s something I’d like you to explain. Why do you see government as the ultimate evil, when — I would contend — it’s the mammoth multi-national corporations that wield the real power and are the the true threats to our freedom. At least we have SOME input into what the government does. Why should we not put some restrictions on their power?

  9. Thorne I know you got batted around a bit and you were just playing devils advocate in your questions.

    A direct answer to your question is simple.
    1) Corporations cannot spend money that they dont have and then demand that US taxpayers, and my kids as future taxpayers, pay taxes to service and retire their debt. Their debt belongs to their shareholders and I can elect to not be a shareholder. I cannot elect to not be a taxpayer. Debt is the single largest threat to the future well being of our nation.

    2) Corporations that behave badly can be corrected by consumers as long as the government will allow corporations to experience the consequences of their bad choices. Governments that behave badly can rarely be corrected, even at the ballot box.

    3)Corporations cannot coerce me to behave a certain way using my own money. Governments take my money and then demand that I behave a certain way in order for a portion of it to be returned. Examples are prolific, federal education funding, federal transportation funding, federal land use policies. Governments seek to limit the liberties of their citizens to control behavior. Corporations use pricing and other incentives to control behavior which is often a benefit to consumers.

    4) Show me a global corporation that ignores its customers and provides poor service and I will show you a corporation that has been insulated from failure by government regulation. Perfect example, Health Insurance companies, Energy Companies, Military Contractors. Companies that are the least regulated, are the most responsive to their consumers. Example, global electronics, retail, manufacturing and service companies.

    There of course has to be regulation of corporations. The larger or more complex the corporation or product the more regulation is needed. What happens though, is that when a corporation messes up, governments realize the affected consumers or workers are also voters. So they step in to “fix” the problem via legislation or regulation and curry favor at the next election. The corportation doesn’t experience the consequences of its mistakes and doesnt adequately change its behavior. More and more regulation leads to less and less accountability until we have institutionalized the bad behavior.

    I see that as the predominate failing of Progressives. The regulation of business to the extent that they are no longer accountable to their consumers. Instead they become accountable to government handlers.

  10. Richard says:

    Continuing my reply to my and your comments of 28 March which I began on 29 March (above.) I could take the easy way out and answer all of your “What if they were…’s with a simple What if they weren’t… But you have made some serious postulations, so, here are my serious views on each.
    Driven by misogynist, racist philosophies: I don’t know what the philosophy of the T-baggers is, I don’t think they have addressed the fundamental questions of who they are and what they believe in as to existence or values or reason, they don’t have an “ism.” One word that will tell us exactly where they are at, as things progress they will have to define themselves, not for us but for themselves. When that becomes clear we will be able to view their ism alongside all the other isms, communism, Socialism, anarchism, capitalism and contrast and compare. There is little evidence that they are misogynist in nature, it’s hard to imagine that they are brought together by a hatred of women, I think that distinction is reserved for some special psychos. Sexist and racist acts are certainly rift within that movement, a part of which can be explained with the ism, Americanism. This is a racist and sexist country and the red-necky, countrified, crowd is more open about their aberrant views, than say the closet racist and sexist that are drawn to the progressive (what the fuck ever that is) demos. Which I might add the progressives don’t have. When is the last time the left side had a huge turnout demo, a classical direct-action, or did anything to give the man the willies. They are an angry mob, not sure where to direct their anger, they, like all the rest of us are getting screwed, they say by the government, we say by the corporations. We are probably both right. Direct action is a very good way to express that anger, they did some. We talked about doing it but the conversation drifted to the good old days when we used to do it. I support their direct action because not only is it fun, it has an effect. Of course I couldn’t support a direct action whose purpose was sexist or racist. I can support their Direct Action against the congress lady even if some of them who took part are sexist and/or racist, after all this is Amerikkka. *more to come*

  11. Richard says:

    A striking objective anaylsis of the T-baggers anti-government position.

    Thanks, I got it saved and will re-read and refer to it as time goes along.

  12. Richard says:

    >What if much of their rhetoric was hateful or mean spirited? < Do you mean that they talk nasty about the government, a government that hates them and is mean spirited to us all? Hateful and mean spirited rhetoric has been my and my families stock in trade for many years, (I don’t want to put a number on it.) We call a pig a pig, and to their face when the opportunity arises. We call Killer-cops, just that, Killer-cops. We call baby killers, killers; we name the enemy for what they are. We say “our boys” who wantonly kill civilians “over there” are murderers and call for their lynching with a yellow ribbon. I not only have a hateful and mean spirited rhetorical style I am hateful and mean spirited in action. I love a riot. I love the opportunity to put the clubbers and pigs that put their jack boots on the necks of the people to the club and to my boots and bricks. I come from fighters, if we can’t meet violence with violence and win; we are doomed to lose to the perpetrators of government violence. Our families’ motto isn’t ArmedLove for nothing. If they see the government as their enemy, they are right. If they call for an end to government injustice, they are right. If they continue Direct Action they will soon taste the pepper gas, and feel the sting of the club, and if they fight back and defend their movement, they are right. Who won the WTO battle in Seattle in 1999, we did, the anarchist. And who won the street battles there, Black Bloc, hateful, mean spirited anarchist who were not and are not afraid to meet the Capitalist, corporate, government storm troopers in the streets and beat them. “The streets belong to the people.” You will never talk the man out of his privilege and power, nor will you vote them out of it. If T-baggers are willing to talk mean and be mean they can make change…We shall see what we shall see. Cataclysmic change comes from chaotic phenomenon, hateful and mean spirited words and action help to create that much needed chaos.

  13. Richard says:

    >And if they called for violent retaliation — not against the state, but against individuals with whom they simply disagreed? < Apparently the T-baggers want change. Not phony change and not simply the change of words that BHO is feeding us, but a change of deeds. They want the government to change. The government won’t change unless it is forced to. I don’t know who or what individuals that they have called for violent retaliation against, but the government is made up of individuals. You cannot retaliate against “the state” without involving the individuals that represent and are the state. From the foot soldiers of the state, that Marxian “special body of armed men,” to the officials that direct those foot soldiers, to the legislators who provide the authority to them, all are individuals. The state is not a mythical imaginary illusion, it is people, and in the present case it is evil and corrupt individuals that use the power of the state, not to serve the people but to intimidate and repress the people to the point of rendering them helpless, by force if necessary. They ripped us off, for billions, and there should be retaliation against the perpetrators of that rip-off, or else they are just talking, “simply disagreeing.”

  14. Richard says:

    And what if they were financed and controlled (at least to a great extent, as is the case here) by rich elements within the ruling class? Very often anti-government movements are financed by rich elements, and let’s face it when you talk rich elements you are talking ruling class. Those elements hope to garner favor or enlist or co-opt that movement to their own evil purposes, and sometimes it works. Sometimes it doesn’t. Here’s a case in point, it’s about Texas, Austin in fact. “Stop the Draft Week,” had to be the fall of ’69. The opportunity to organize something fell to me and an anti-war GI. We rounded up the usual co-conspirators and made some plans. It was low budget but not exactly free. We hit up a local liberal (kinda) politician. He saw this as an opportunity to ingratiate himself with our movement and gave us $500, in the form of his secretary’s check. We spent the 1st hundred on some Mexican weed and the rest on props for the guerrilla theater, gas for transportation etc. Didn’t help the pol at all because until this very moment no one knew where we got the bucks. Couple hundred people turned out, made the papers, the TV, and it was even written up in the real Rag. Just because they get money from rich people does not mean the contributors get anything back. As to control, I think there is control from idiots like Beck and those people on faux news, because some T-baggers are dumb enough to believe the bullshit they are passing out. For the most part T-baggers are self funded as we were, their contributors will find out that “money can’t buy you love, can’t buy you love… Sing along with me. I don’t want to say the politicians name but his initials are RY. So, a lot of politicians want to turn their movement into votes, they even had the Wasilla hillbillies speak at one of their gatherings, that don’t mean she will benefit from it. There is still time for them to see that the best Direct Action for November is to not Vote. If they think that voting in some Republican will change anything they are mistaken. *more to come*

  15. Richard says:

    >And what if they were not only overtly anti-intellectual but were also fueled by and were championing blatantly and demonstrably inaccurate and dangerous information.< Anti-intellectualism on the part of the T-baggers is balanced by intellectual elitism on the left side, as an example refer to the 1st comment in this thread by Dr. McAdoo. Neither position will further the struggle, what will further the struggle is ACTION. I wish I was always right, but alas that is not to be. If I were always right I would have spent the last seven decades learning nothing, we only learn from our mistakes. As to my Anarchist beliefs, I spent many years as a post-scarcity Anarchist, even when I was living as an anarchist-primitivist I still believed in the possibility of a post-scarcity world where Capitalism would not be possible. A few years later thanks to the intellectualism of Fredy Perlman and Dave Watson I discovered that my anarchist-primitivist life style actually had a name and a viable philosophy. I learned from my mistake. T-baggers will learn from their anti-intellectualism mistake, it is not my job to point that out to them, at some point they will get stuck and will need to disabuse themselves of their anti-intellectualism to move on. In the meantime, their move to Direct Action will hasten their realization that they have to have a philosophy and that they have to articulate their movement’s position and belief as to existence, and values, in doing so they will discover their mistakes…and maybe correct them, or die. Presently, there is a strong “Christian right” element in their movement, this is probably the biggest impediment to the development and articulation of a T-bagger philosophy. They have to move beyond, “gawd’s will,” to “cause and effect.” In doing so, they will come face to face with the “inaccurate and dangerous information that they are championing.” While you see no value to their movement, their opposition to our criminal government is invaluable. Should they disband today, and their legacy were little more than that, it would have some value to our continuing struggle. *more to come*

  16. Richard says:

    >Isn’t the philosophy of anarchism based in a belief that people can (and should) work together with mutual respect and create associations and institutions that can fulfill their mutual needs…< This is a two part question. First the first part: >isn’t the philosophy of anarchism based in a belief that people can (and should) work together with mutual respect and create associations and institutions that can fulfill their mutual needs…< Indeed there are some parts of the Anarchist philosophy that support this postulation, but the same could be said for the philosophies of Communism, Socialism, to an extent Liberalism, and all other isms that are based in co-operation rather than competition. The second part: >outside the structure of a nation state? < First we must get outside the structure, i.e. the authoritarianism of the state, to do that we must destroy the power of the state, this leads us to revolution in the Bakunin sense, wherein the power of the state is destroyed by violent means…”A revolution is not a dinner party.” Creating co-operative associations which cannot be defended from the depredations of the state is simply not worth it, the ones that are allowed to exist are the ones that do not challenge the State’s authority. Well…those are my answers, aren’t you glad you asked?

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