This Week: Health Care and the Candidates and the Media

"Quote" of the Week

The Corporate Agenda Is "All The Rage"

Rock the Boat, Lose the Vote: Investing In the "Right" Democrats

Greetings,

This week I take a close look at two articles from the New York Times, the nation's most influential and powerful newspaper. They are both about health care but, despite appearing on consecutive days, were not linked together by the Times in any way that I could tell. In fact, I think they are closely linked, and I explain why they are, and why the Times, predictably, got it all wrong. There's much to be learned in the process, as I think you'll see.

I've been out of town, and before that I was consumed with the biennial Nygaard Notes Pledge Drive, so I haven't been reporting as much as usual on the highly-enlightening and revealing news that has appeared in the media over the past month or two. My plan, then, starting next week, is to spend a couple of weeks strolling through recent news, pointing out the irony in the headlines and the important stuff buried on the inside pages. That is, unless something more important comes up in the meantime.

THANK YOU THANK YOU THANK YOU to all who made a Pledge of support for the Notes. You keep it going. You're amazing!

Nygaard

"Quote" of the Week:

From a Los Angeles Times poll released October 24:

"A slim majority of 53% ... support a single-payer government plan that would extend Medicare to all Americans, driven again by the enthusiastic support of Democrats (64%) and the somewhat less keen independents (51%). More than six out of 10 Republicans oppose such a plan."

Various other polls show similar results.

The Corporate Agenda Is "All The Rage"

The New York Times on October 30th ran a story headlined "Looking at Dutch and Swiss Health Systems." The article led off with the whiz-bang sentence, "The Swiss and Dutch health care systems are suddenly all the rage." This is because, the Times tells us, "They have features similar to proposals by at least two presidential hopefuls."

In the article we learn that U.S. Health and Human Services Secretary Michael O. Leavitt will visit the two countries next week, a visit that "arose, health department officials said, because policy experts here [in Washington] have promoted Swiss and Dutch changes as models" for the U.S.

That was all in the first three paragraphs. If you are anything like me, you might have asked "What makes these countries models?" Is it because they do a better job than our country in the ways that our health system's failures are the most obvious, like the health of the population, and the cost to society of maintaining the health care system? No. Amazingly, neither of these factors were mentioned in the article, nor did they appear to be motivation for choosing these "models."

Still, unnamed "other experts" quoted by the Times "are endorsing the two countries' health systems" for SOME reason. Those "other experts" appear to include a group known as "America's Health Insurance Plans" which calls itself "the voice of America's health insurers" and whose "goal is to provide a unified voice for the health care financing industry."

Their spokesperson told the Times that "The only models we seem to focus on here are those in Canada and Great Britain, which both have government-run systems. We thought it made sense to look at two countries that have universal coverage but rely on the private sector to get there." (Canada, of course, does not have a "government-run" system—it's a single-payer system—and the Times did us wrong by quoting this professional propagandist who says it does. See NN #101 "Canadian Health Care: Nuts and Bolts.")

Model of Health? Model of Efficiency?

Let's have a look at the a few countries as they compare with the U.S. on my two criteria: EFFICIENCY in the provision of care, and the HEALTH of the population.

First, here are some rankings in terms of their national spending on health care as a percentage of Gross Domestic Product: The U.S. is the worst (that is, most expensive), by a LONG way, spending 15.4 percent of our GDP on health care. Next-worst is the "model" Switzerland, at 11.5 percent. The Netherlands comes in at 9.2 percent, Canada at 9.8 percent, England at 8.1 percent, and Cuba spends a mere 6.3 percent. It's not really a fair comparison, as every country on the list not only spends less than the U.S., but has a financing system that provides coverage to far more people That is, everyone.

One of the best single indicators of a nation's health is infant mortality. Here are a few countries and where they stand. The U.S. is down the list, with a rank of 41st among the nations of the world. The Netherlands and Switzerland are better than that, ranking 25th and 12th, respectively. Canada comes in at number 22, England at 28, Norway at 7, France at 5, and Sweden ranks 2nd in the world (behind Singapore). Tiny, impoverished Cuba ranks 39th, a couple of notches above the United States.

Needless to say, all of the above countries, except the U.S. have some form of universal health care, coordinated at the national level and, to varying degrees, financed by public funds. More questions come to mind: Why is Sweden, for instance, not a "model" for the U.S., as its people seem to be far healthier than we are, with a roughly-similar level of wealth? Why aren't England or Cuba "models" for the U.S., since they have universal systems and spend far less of their national wealth to have them?

Well, the answer was provided for us, although it was somewhat encoded, by the Times report: In order for a country to be a "model" that will be "endorsed" by the industry and the "experts" who are funded by them, that country needs to "rely on the private sector" to do the job.

The Times got ahold of one Robert Blendon, who is a professor of health policy and political analysis at the Harvard School of Public Health, who "said interest in the Swiss and Dutch models had soared among policy experts because of a growing consensus that the United States would never adopt a single-payer system." I don't know what "growing consensus" they're talking about, as a Los Angeles Times poll completed just last week found that "53 percent [of United Statesians] support a single-payer government plan that would extend Medicare to all Americans, driven again by the enthusiastic support of Democrats (64 percent)."

Apparently that "growing consensus" only includes the people who count, which would be the "policy experts" who tell us that there is a "growing consensus." And might this have something to do with the power of the "health care financing industry," an industry the elimination of which is a large part of the point of a single-payer approach to financing health care? I think it might.

The Times article mentions that the proposals of Hilary Clinton and John Edwards "borrow heavily" from the Swiss and Dutch models. And, not surprisingly, their campaigns are funded heavily by the very "private sector" upon which their proposals "rely," and who stand to profit greatly from a maintenance of business as usual. (And I do mean "business.")

The article that follows takes a look at how the "private sector" goes about "growing" a desirable "consensus," and all before anyone casts a vote.

Rock the Boat, Lose the Vote: Investing In the "Right" Democrats

A couple of presidential elections ago, in January of the year 2000, I wrote an article called "So... How About That Campaign?". In it I recounted the following anecdote: A leader of a Political Action Committee, or PAC, was on Minnesota Public Radio to respond to an accusation that money from groups like his has deformed and corrupted our political system. Here's what he said in his defense: "We don't ever try to buy politicians in Minnesota because, frankly, I don't think they are ‘buyable.' What we do is, we study their records and their statements. If we like what they are doing, we say to them, ‘Hey, we know campaigns are expensive, and we want to help you get your ideas out to the public.' That's how we make our decisions on whose campaign to contribute to."

And that, in a nutshell, explains what I call The Investment Theory of Money in Politics.

The Investment Theory was illustrated in a front-page article this week (October 29, 2007) in the New York Times. The headline read "In a Reversal, the Health Sector Puts Its Money on Democrats." This is a classic example of an article that gets the facts right, but the story wrong. However, the facts it does provide tell a lot, providing one can decode, reorganize, and contextualize the garbled and confusing article that was actually published.

The "Health Sector" to which the article refers is composed of "Hospitals, drug makers, doctors and insurers" who "gave candidates in both parties more than $11 million in the first nine months of this year." Of this, Democrats got $6.5 million, and Republicans nearly $4.8 million. Apparently, the Times considered this newsworthy—front-pageworthy, even—because most of the corporate health money is not going to the Republicans, as it did in the previous two election cycles. "The industry's shift in contributions toward Democratic candidates," the Times tells us, is "particularly notable because of the party's focus on overhauling the health care system."

Overhauling? Hardly. The Obama plan promises merely to "reform the private insurance market." Under the Clinton plan "individuals...will be responsible for getting and keeping insurance." And the Edwards plan has the government "requiring all American residents to get insurance." Private health insurance, it goes without saying.

And I do mean "without saying," as the Times uses the word "private" only once in their lengthy article, when it warns that the Clinton plan "calls for changes to the health care system that could pose serious financial challenges to private insurers..." Yet, somehow, the industry has seen fit to give $2.7 million to Ms. Clinton's campaign, by far the most of any candidate, Republican or Democrat. Do they think Hilary—net worth: $10 million to $50 million—is "buyable"? Not likely.

Facts Right, Story Wrong

About halfway through the article the Times tells us that "One of Mr. Obama's fund-raisers, Kirk Dornbush, president of Iconic Therapeutics, a biotech company in Atlanta, said, ‘The contributions reflect the simple calculus of the health care industry, making a bet that Democrats will control the White House and both houses of Congress after the next election.'" And here's where the Times got the story wrong, and always gets the story wrong: It's not about Democrats and Republicans. It doesn't really matter to the "industry" which party is in power, as long as whoever is in the White House will not dare—or, better yet, will not desire—to rock the very-profitable health care boat.

How profitable is that boat? While administrative costs for the government-run Medicare program run between 1 and 2 percent, overhead for the private insurance industry comes in between 15 and 20 percent, two-thirds of which goes to "functions essential to private insurance but absent in public programs, such as underwriting and marketing," according to the New England Journal of Medicine. A Harvard/Public Citizen report in 2003 found that implementation of a single-payer system in the U.S. "could save about $286 billion in administrative costs." For perspective, consider that, if that amount of money were to go toward providing health care rather than into the pockets of the "health sector," it would be enough to "provide health coverage for the uninsured [and] provide drug coverage for the nation's seniors."

The Times article, as is typical, reports that the millions of dollars in campaign contributions reflects "the industry's frantic effort to influence the candidates." This implies that the recipients of this cash are "buyable." This thinking is supported by a senior vice president of the Blue Cross and Blue Shield Association, who told the Times, "As long as the candidates are willing to talk to us, we can educate them."

Well, really. If they needed to be "educated," it's not likely that they would have already received sufficient money to make them a "serious" candidate. Remember the Investment Theory: The givers in the "health sector" might be heard to say the same thing that the PAC-man stated at the beginning of this article, that "we study their records and their statements. If we like what they are doing," we give them money "to help them get their ideas out to the public."

And, in an obvious corollary, those candidates who are doing or saying things that the moneyed classes do NOT like will NOT get the money necessary (in our current system) to "get their ideas out to the public."

The Times says in their first paragraph that the proposals of the Leading Democrats "have caused deep anxiety" in the industry. Yet none of their "leaders"—Clinton, Obama, and Edwards—are talking about doing what many other countries have done, which is to get rid of private health insurance altogether. Now, THAT would cause "deep anxiety."

How could we get rid of the insurance industry? Well, we could socialize the health-care system, as we have socialized other large parts of our economy (waste disposal, transportation infrastructure, the military, etc). No candidate has suggested such a thing. But there is a compromise between the current system and a fully-socialized system, and that compromise is a single-payer system.

The Times reports that "Health care providers disagree with many of the Democrats' specific proposals." A crucial point is again left unsaid: They disagree with some proposals much more than others. And one proposal that cannot be allowed into the debate is "single-payer." The word never appears in the Times article, and rarely appears anywhere in the corporate media, except when an "expert" is found to say that it can't happen here.

Of the eight visible candidates in the running for the Democratic nomination for President (there are 38 more registered, but invisible, candidates), one, Dennis Kucinich, is actually a co-sponsor of the United States National Health Insurance Act, H.R. 676. This bill, also called the "Expanded and Improved Medicare for All Act," would establish a "unique American universal health insurance program with single payer financing," according to John Conyers, the lead author of the bill.

This compromise position is often portrayed as a "fringe" position, out of touch with the mainstream of the Democratic Party. The polls show otherwise, all the more remarkable given the lack of any serious discussion of the idea in the daily media.

And so the Marketplace of Ideas comes to resemble the actual marketplace: It's not One Person/One Vote, but One Dollar/One Vote. And some Persons have a lot more Dollars than others. As long as our media follows the Dollars and not the Ideas, we'll get horse races and we'll get marketplaces, but we won't get Democracy. There is, after all, no profit in that.