The bottom line in health care

In my previous post on Single-payer health care: Why not?, I talked about our family’s experiences with health care in France, UK, Ireland, Italy, China, Australia, and other places in comparison to that in the US. This included health care for children and the elderly, and both minor (blood donation, physicals, skin growth removal) and major (broken hip, eye infection) procedures.

Thinking a bit more about this I realized that there were four essential facts that emerged from this wide variety of experiences. In every industrialized country except the US,

1. Equitable: Everyone has the right to health care.
2. Effective: People live longer, healthier lives.
3. Economical: They spend less on health care, as much as 50% less.
4. Efficient: There is much less bureaucracy, fewer forms, less running around, less waiting.

I might add a fifth point, too: The scare stories that we hear (“you have to wait forever!” “you can’t choose your doctor!”) are simply false, or they index issues that are the same or worse in the US. The information we get about health care promotes profit, not health.

There are many issues–changing demographics, new technologies, new medical knowledge, changing standards, globalization, and more–which affect health care. But the fundamental difference in the current US situation is that health care is driven by the bottom line. Insurance companies, pharmaceutical companies, media corporations, hospitals and clinics, doctors and other health care professionals, and all others involved in health care operate in a system in which rewards bear little relation to the overall quality of care or efficient use of resources.

One can debate each of the points above, but the evidence from OECD, UN, WHO, WTO, and other international organizations is overwhelming in support of them. Other systems offer health care that is more equitable, more effective, more economical, and more efficient.

So, why is single-payer, or national health care not even worth discussing? Why does the Obama plan dismiss it? Why does even public broadcasting ignore it?

 

A new beginning against extremism

Obama’s speech yesterday at Cairo University (photo at left) was beautiful. It represents a new beginning against extremism both in the US and abroad. Even Osama Bin Laden recognized that it challenges a linchpin of al-Qaida’s message.

I don’t agree with many of the current Administration’s foreign policies (escalation of the Afghanistan-Pakistan war, inadequate engagement with the Caribbean, especially with respect to Cuba, and not doing more for Haiti, failure to close Guantanamo and re-establish justice following years of officially sanctioned torture and renditions, etc.), but opening dialogue is a first step towards a rational, humane, and effective foreign policy.

The ending of the speech is classic Obama:

It’s easier to start wars than to end them. It’s easier to blame others than to look inward. It’s easier to see what is different about someone than to find the things we share. But we should choose the right path, not just the easy path. There’s one rule that lies at the heart of every religion — that we do unto others as we would have them do unto us. This truth transcends nations and peoples — a belief that isn’t new; that isn’t black or white or brown; that isn’t Christian or Muslim or Jew. It’s a belief that pulsed in the cradle of civilization, and that still beats in the hearts of billions around the world. It’s a faith in other people, and it’s what brought me here today.

We have the power to make the world we seek, but only if we have the courage to make a new beginning, keeping in mind what has been written.

The Holy Koran tells us: “O mankind! We have created you male and a female; and we have made you into nations and tribes so that you may know one another.”

The Talmud tells us: “The whole of the Torah is for the purpose of promoting peace.”

The Holy Bible tells us: “Blessed are the peacemakers, for they shall be called sons of God.”

The people of the world can live together in peace. We know that is God’s vision. Now that must be our work here on Earth.

Thank you. And may God’s peace be upon you. Thank you very much. Thank you.

See Obama hits a home run, by Robert Dreyfuss.

 

Single-payer health care: Why not?

I’ve been fortunate to have traveled many places, and to have lived for extended periods in China, Australia, France, and Ireland. During those travels, my family has received health care on many occasions, including for our small children in China and Asutralia, my wife in Scotland, and my 87-year-old mother in Ireland.

This health care has come in a variety of forms, including treatment for my ten-year-old daughter’s eyes at the Hospitaller Order of St. John of God or Fatebenefratelli (see left), located on San Bartolomeo, the only island in the Tiber River in Rome. That hospital was built in 1584 on the site of the Aesculapius temple.

We also faced emergency surgery for my mother’s hip at Beaumont Hospital in Dublin, Ireland and subsequent rehab at the Orthopaedic Hospital of Ireland in Clontarf (right). In China, we were served in medical facilities with separate queues for Western medicine (our choice) and traditional Chinese medicine (below left). I donated blood many times at the Hôtel-Dieu de Paris, founded in 651 on the Ile de la Cité (below right). I’ve also observed, though not had to depend upon, health care in Russia and even in economically oppressed places such as Haiti.

On the whole, I’ve received excellent care in a variety of conditions. Individual health providers have been courteous, knowledgeable, and dedicated to their professions. For myself and my family, the experience of care did not depend on the setting or language, but rather on the ailment or the specific people providing care.

And yet, one thing stands out: Among the industrialized nations, the United States is the only one without universal health care. All of the others provide health care for all. They also do it primarily through single-payer systems.

The United States operates instead through a complex bureaucracy of insurance policies, doughnut hole prescription drug coverage, forms and regulations galore, massive administration, unnecessary and excessive procedures, complex and confusing tax codes, leading to escalating costs and unfair coverage. The inequity of care actually costs all of us more in the end, because of lack of preventative care, inefficient delivery (e.g., emergency rooms), and lost productivity. Our system costs much more, even double that found in other countries.

If we were to find that spending a few dollars more gave us better care, there might be little room for argument. But in comparable economies, people spend much less, yet have longer, healthier lives (American Health Care: A System to Die For: Health Care for All). Why then, is the system that works in Canada, Japan, Europe, Australia, etc., not even under consideration here?

The answer is unfortunately all too obvious: Americans, unlike citizens in other countries, have ceded control of their own health care to profit-making insurance companies, hospitals, clinics, laboratories, pharmaceutical companies, and other entities. The best we can do is an occasional feeble cheer when someone asks why our government can’t even consider a single-payer system. Then we listen to an answer that mostly obfuscates and lays the blame for it back on our own timidity:

 

RiseOut: “Defining Our Own Education”

I’ve been reading the articles on RiseOut, an online “news center focused on deschooling, youth activism, and other related issues concerning the rights of youth in the U.S.” There are entries on deschooling; unschooling; youth media; racism; the Highlander Folk School in New Market, Tennessee; Dr. “Patch” Adams; a review of the book, The Teenage Liberation Handbook, How to quit school and get a real life and education (by Grace Llewellyn); critiques of school segregation (and recent Supreme Court decisions that support it), credentialism, and military conscription.

Most of the articles on RiseOut are well-researched, thoughtful, and provocative. They remind me of the wonderful book, Letter to a teacher by the schoolboys of Barbiana, in which youth in Italy present a searing critique of their education and the unjust society it supports.

Both the Barbiana book and RiseOut address the question that Earl Kelley asks: What is real in education?. Kelley answers that the bedrock reality is the the actual life of youth.

The Obama administration’s proposed “Cradle to Career” education plan, has many good components, but education reform will never accomplish much if schooling continues to be separated from actual life and fails to come to terms with the issues raised in RiseOut.

From the RiseOut site:

We provide a diversity of alternatives to education that are self-directed and decentralized from standardized schooling. We support a young person’s choice in dropping out of school, free of social stereotypes and biases. We aim to provide a plethora of alternatives from a 12-year prison like sentence of state schooling, while staying vigilant of abuses against young people through diagnosing, segregation, ageism, adultism, sexism, and other assholisms.

A message to those who have decided to quit school:

Instead of dropping out, we applaud you for your courage to “riseout” from a nightmarish disposition of compulsory schooling. We hope RiseOut can be a resource for sharing your stories and providing choices towards regaining control over your own education.

 

Obama upholds discrimination

Barack Obama is on track to become not just a good, but one of the great US Presidents. But yesterday he made a big mistake.

Obama let stand Bush’s executive order allowing religious organizations to discriminate in hiring on the basis of faith and still receive federal funding. Discrimination on the basis of religion is a direct violation of the First Amendment. And because many faith-based organizations are 100% of one race and one language, have prescribed roles for men and women, and often exclude homosexuals and others who don’t fit their doctrines, this order means that invidious discrimination supported by everyone’s tax dollars is now enshrined in Federal policy. The Constitution protects everyone’s right to associate with those they choose, but it also forbids unequal treatment under the law.

Obama had rightly questioned this policy during the campaign, saying “if you get a federal grant, you can’t use that grant money to proselytize to the people you help and you can’t discriminate against them–or against the people you hire–on the basis of their religion.”

He was right then and wrong yesterday.

See Obama upholds Bush faith policy – Los Angeles Times.

 

David Bergman’s 1,474-megapixel photo of Obama’s inauguration

David Bergman made an amazing 1,474-megapixel panoramic photo during President Obama’s inaugural address. The detail in the image is impressive; Bergman describes how he found Yo-Yo Ma taking a picture with his iPhone.

The photo is a valuable record of the historic event as well as a technological/artistic tour de force. You can explore the photo itself online and read about how he did it on his blog.

CNN has another photosynth version of this based on photos sent in by diverse individuals at the event:

 

Remaining Awake Through a Great Revolution

On November 4, voters in the US made a momentous choice, not only by taking another step towards racial equality, but also by demanding new ways of relating to other countries, to injustice, to the environment, and to truth itself. As of today, that is only one step; nothing has changed except the direction we are pointed.

Where the path leads next depends even more on the rest of us than it does on President-Elect Obama. The great challenges of globalization, racism, poverty, and violence are unaffected by a single election. Yet, there is a risk that we can fall asleep, lose sight of those challenges, and begin to think only of narrow issues, such as many that surfaced in the campaign.

We have the opportunity now to respond to the challenges posed 43 years ago in Martin Luther King, Jr.’s excellent speech, Remaining Awake Through a Great Revolution. In his talk, he relates the story of “Rip Van Winkle,” who slept 20 years. But he reminds us that when Rip went up to the mountain, the sign on the local inn had a picture of King George III of England. Twenty years later, the sign had a picture of George Washington. Rip had not only slept 20 years; he had slept through a revolution. As King says, “Rip Van Winkle knew nothing about it; he was asleep.”

King saw that we are experiencing a scientific and technological revolution, one that challenges us to remain awake, and to develop a world perspective. It’s more imperative than ever to eradicate racial injustice and rid the world of poverty, and to find an alternative to war and bloodshed. Long before talk of flat worlds, King saw that our destinies were intertwined:

All I’m saying is simply this: that all mankind is tied together; all life is interrelated, and we are all caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. For some strange reason I can never be what I ought to be until you are what you ought to be. And you can never be what you ought to be until I am what I ought to be – this is the interrelated structure of reality…And by believing this, by living out this fact, we will be able to remain awake through a great revolution.

Remaining awake means looking beyond government as usual and recognizing that children in Haiti are in our “garment of destiny,” as much a part of our world as the person next door. It means knowing that justice is an ongoing project that needs to be defended wherever we hear of abuses of human rights, not seeking ways to justify them. It means finding an end to wars, not simply moving from one venue to another.

Can we do any better now at addressing King’s great challenges?

References

King, Jr, Martin Luther (1965, June). Remaining awake through a great revolution. Commencement address for Oberlin College, Oberlin Ohio.

 

Bill Ayers interview

Bill Ayers gave his first interview after the election on NPR’s Fresh Air on Tuesday. It’s very interesting,  providing some context on a bizarre aspect of the Presidential race this year. Terry Gross gets him to speak freely and also asks probing questions about the war in Vietnam, the 60’s, terrorism, means v. ends, politics, imperialism, and the personal impact.

Fresh Air from WHYY, November 18, 2008 · The name of former anti-war activist William Ayers was brought up twice in an attempt to discredit Barack Obama during the recent presidential campaign — first by Hillary Clinton, and then by the McCain campaign. Republican vice presidential candidate Sarah Palin accused Obama — who served on two nonprofit boards with Ayers — of “palling around with terrorists.”

The accusations stemmed from Ayers’ involvement with the Weather Underground, a radical group responsible for bombings on the New York City Police Department headquarters in 1970, the U.S. Capitol building in 1971 and the Pentagon in 1972. The federal case against Ayers was dismissed in the early 1970s.

Ayers is a professor at the University of Illinois at Chicago and the author of ‘Fugitive Days: Memoirs of an Anti-War Activist.’

Ayers will be a guest-in-residence on the Urbana-Champaign campus this coming March 8-12.

 

Creative democracy: Yes we can!

Yesterday’s election of Barack Obama as President of the United States was not only promising for our future, but was also a moving reaffirmation of all that America can be.

His Presidency may not fulfill all the dreams that the candidacy inspired; some things may not change at all. But it reminds me of what Thurgood Marshall said after the Brown v. Board of Education decision in 1954, which outlawed segregated schools. When asked what the Supreme Court ruling really meant, Marshall, said that in fact nothing had changed, except that henceforth, repeating the civil rights mantra, “the law is on our side”. In a similar way, Obama’s Presidency offers no guarantees, but does offer exciting possibilities in terms of uniting Americans and restoring America’s role in the community of nations.

The election of Obama is also a reminder that democracy is not a static system, but a process in need of continual renewal by all. Dewey (1976/1939, p. 230) expresses this in his essay, “Creative democracy: The task before us”:

Democracy as compared with other ways of life is the sole way of living which believes wholeheartedly in the process of experience as end and as means; as that which is capable of generating the science which is the sole dependable authority for the direction of further experience and which releases emotions, needs and desires so as to call into being the things that have not existed in the past. For every way of life that fails in its democracy limits the contacts, the exchanges, the communications, the interactions by which experience is steadied while it is also enlarged and enriched. The task of this release and enrichment is one that has to be carried on day by day. Since it is one that can have no end till experience itself comes to an end, the task of democracy is forever that of creation of a freer and more humane experience in which all share and to which all contribute.

Let’s have the audacity to hope that we are capable of creating of “a freer and more humane experience in which all share and to which all contribute.” I might add that John McCain’s concession speech was a gracious and thoughtful step in that direction.

References

Dewey, John (1976). Creative democracy: The task before us. In J. Boydston (Ed.), John Dewey: The later works, 1925-1953, volume 14 (pp. 224-230). Carbondale: Southern Illinois University Press. (Original work published 1939)

Kluger, Richard (1977, 1975). Simple justice. The history of Brown v. Board of Education and Black America’s struggle for equality. New York: Vintage Books.

 

Powell asks, “What if he is?”

Colin Powell’s endorsement of Barack Obama for President was a powerful statement from a much-respected figure. It will certainly help Obama’s campaign. But at least as significant was his challenge of Islamophobia:

I’m also troubled by, not what Senator McCain says, but what members of the party say, and it is permitted to be said. Such things as ‘Well you know that Mr. Obama is a Muslim.’ Well the correct answer is ‘He is not a Muslim, he’s a Christian, he’s always been a Christian.’ But the really right answer is ‘What if he is? Is there something wrong with being a Muslim in this country?’ The answer is ‘No. That’s not America.’ Is there something wrong with some 7-year old Muslim-American kid believing that he or she can be president? Yet I have heard senior members of my own party drop the suggestion he’s a Muslim and he might be associated with terrorists. This is not the way we should be doing it in America.

I feel strongly about this particular point because of a picture I saw in a magazine. It was a photo-essay about troops who were serving in Iraq and Afghanistan. And one picture at the tail end of this photo essay was of a mother in Arlington Cemetery and she had her head on the headstone of her son’s grave. And as the picture focused in you can see the writing on the headstone. And it gave his awards, Purple Heart, Bronze Star, showed that he died in Iraq, gave his date of birth, date of death. He was 20 years old. And then at the very top of the headstone, it didn’t have a Christian cross, it didn’t have a Star of David. It had a crescent and a star of the Islamic faith. And his name was Karim Rashad Sultan Khan. And he was an American, he was born in New Jersey, he was 14 years old at the time of 9/11 and he waited until he can go serve his country and he gave his life. [Photo courtesy of Tom Gugiluzza-Smith, August 2008]

Powell is not the first to make this point, but it’s difficult to name another such prominent political leader who has done so. Others, including Obama himself, have focused on the fact that some statements about his ethnic or religious background have been false, not on the bigotry revealed by the very question itself. Ignoring the presupposition of those questions shows a lack of understanding and respect for the US Constitution, which should bring shame on Republican and Democratic leaders alike.

See Abed Z. Bhuyan, On Faith: Guest Voices: Powell Rejects Islamophobia