Bernie Sanders and the Crisis of Unpayable Medical Debt

Tears in the eyes of many at @BernieSanders medical debt town hall in Des Mones [sic]. As attendees tell their stories about ICUs, debt collectors, and coverage denials almost all have said that Sanders is “the only one I can trust” to alleviate their financial emotional burdens pic.twitter.com/rpWWgIXYdU

— Cara Korte (@CaraKorte) September 22, 2019

by Thomas Neuburger

Bernie Sanders' new medical debt plan is called "Eliminating Medical Debt," but that title is a bit misleading. The plan does aim to erase the burden of past-due medical debt through a government buy-down. But the plan does a whole lot more.

There's no doubt that, for many families, medical debt is at least as heavy a burden as student debt. As David Sirota writes in his newsletter Bern Notice, "Today, roughly 79 million Americans are struggling to pay their medical bills or are paying off medical debt — and last year alone, 8 million people were pushed into poverty due to medical expenses. Health insurance is no protection: One in six patients with insurance incurred a surprise medical bill in 2017."

Families that are in trouble due to medical debt are in trouble now, and the relief they need is also now. This plan offers it.

Sirota also notes that Sanders' plan directly challenges "lawmakers like Biden who spearheaded legislation that made it so much more difficult to reduce medical debts in the first place."

So the plan is more than a simple debt cancellation or pay-down. It rewrites the Biden-pushed "bankruptcy protection" act of 2005. (Who did the act protect? Creditors, of course.) And, as an added feature, Sanders' plan restructures the credit reporting market, creating a new government agency to replace the private market dominated by for-profit players Equifax, TransUnion and Experian.

The Sanders medical debt plan is truly ground-breaking, both in its scope and its effect, and it's important that it be widely disseminated and understood. Few in the nation's struggling middle class or boot-stomped poor would fail to cheer its enactment. And, I dare to add, few of Sanders competitors for the presidency would dare to endorse its full breadth.

Here are the plan's main goals and the measures it will enact to achieve them.

Eliminate Existing Past-Due Medical Debt

One source of the medical debt problem is past-due debt. Hospitals often aggressively pursue collection of past-due debt from low-income (i.e., uninsured and underinsured) patients. In addition, they frequently resort, in an attempt to recoup at least something from uncollectable debt, to selling that debt to aggressive collection agencies for pennies on the dollar. Those agencies then turn on patients attempting to get repaid in full if at all possible.

Those patients, of course, have no recourse. They are at the end of their rope financially — after all, these aren't people who spent optionally on a house or car. They bought medical treatment, often life itself. They had literally nowhere else to go, have no resources to turn to when bills are due, and no way to turn off the harassment of the wolves surrounding them when they cannot pay.

Here's the Sanders plan to address the debt and collection part of the problem (emphasis mine):

As president, Bernie will:

• Eliminate the $81 billion in past-due medical debt.
  • Under this plan, the federal government will negotiate and pay off past-due medical bills in collections that have been reported to credit agencies.
     
• End abusive and harassing debt collection practices.
  • Prohibit the collection of debt beyond the statute of limitations.
  • Significantly limit the contact attempts per week a collector can make to an individual through any mode of communication, regardless of how many bills are in collection.
  • Require collectors to ensure information about a debt is fully accurate before attempting to collect.
  • Substantially limit the assets that can be seized and the wages that can be garnished in collection to ensure consumers do not lose their homes, jobs, or primary vehicles and will be able to financially support their families.
     
• Instruct the IRS to review the billing and collection practices of the nearly 3,000 non-profit hospitals to ensure they are in line with the charitable care standards for non-profit tax status, and take action against those who are not.

For people constantly hounded by hospitals and debt collectors, this alone would be a godsend.

Reform the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005

Joe Biden bears substantial responsibility for the inability of patients to discharge medical debt through bankruptcy.

As Sirota writes, "One of the major drivers of the debt crisis was the 2005 bankruptcy legislation that Bernie fought — and that Joe Biden helped Republicans ram through Congress. A 2018 study found that the legislation made it far harder for patients to discharge medical debt through bankruptcy after a hospital stay, especially for uninsured patients. Biden split with then-Senator Obama to become just one of only three Democrats to vote against an amendment that would have exempted those with serious medical debt from the harshest parts of the bill. Bernie’s plan would roll back the key provisions of Biden’s 2005 legislation, to make it easier to reduce medical debt."

Here's the part of the Sanders plan that addresses bankruptcy protection (emphasis mine):

Reform the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 to use the existing bankruptcy court system to provide relief for those with burdensome medical debt.

• Eliminate means testing requirements to file for bankruptcy.
• Allow for the adjudication — including potential discharge — of debt, including interest and penalties, stemming from direct payments to providers and insurers for medical expenses. Assuming documentation, this includes medical debt incurred on credit cards or any other consumer debt product.
• End the onerous and regressive “credit counseling” required before filing to discharge medical debt.
• Include broad “automatic stay” protections, placing an immediate prohibition on any evictions, utility (heat, electric, etc.) interruptions, foreclosure proceedings, wage garnishments, driver's license suspensions, and other actions.
• Prohibit requiring the disclosure of medical debt discharge on housing, loan, or other applications.

I hope in the next debate this gets fully discussed. It's both just and Christian (in the real sense) to handle people who are drowning in debt, some of whom may die of it, with mercy. It's also just to expose Joe Biden for who he really is and was — the "senator from MBNA," the senator from Credit Card America.

Replace For-Profit Credit Reporting Agencies

The for-profit credit reporting industry, a near-monopoly dominated by just three companies, does enormous damage to consumers in all of its dealings, but none moreso than in its dealings with consumers who carry large medical debt.

Sirota writes, "Bernie’s plan ends the corporate control of Americans’ credit scores by creating a public credit registry to replace for-profit credit reporting agencies, and by excluding medical debt from credit scores. That is a direct threat to the three corporations that currently control the financial destiny of 140 million Americans. Those three companies — Equifax, TransUnion and Experian — reported more than $10 billion in revenue and more than $1.4 billion in profits last year, while paying their CEOs more than $91 million."

Credit data collection and reporting is an industry that should be treated as a utility and run by government in the public interest instead of by corporations as a profit center. (The argument that Facebook is another is compelling.) After all, U.S. citizens are not this industry's customer — the nation's creditors are — and that's where its loyalties will always lie.

Needless to say, credit reporting inaccuracies and data hacks disproportionately punishes those most in need of good and accurate reports — including and especially the poor and middle class. Including medical debt in credit reports only compounds the problem.

Here's what Sanders will do to restructure this industry:

• Remove and exclude medical debt from existing credit reports.
   
• Create a secure public credit registry to replace for-profit credit reporting agencies.
  • This registry will use a public, transparent algorithm to determine creditworthiness that eliminates racial biases in credit scores.
  • Allow Americans to receive credit scores for free.
  • Prohibit medical debt from being included.
     
• End the use of credit checks for rental housing, employment, insurance and other non-lending practices.

Another godsend, not just for those in medical debt, but for all American consumers.

To paraphrase Joe Biden, I would consider this proposal a very big deal, one that, if widely understood to be part of Sanders' platform, could be a game-changer. It's been clear for years that one of the greatest of our nation's ills is the massive, uncollectable consumer "debt overhang" that sucks life from our lives and hope from each generation — from seniors who retire into poverty, to new college graduates who can't find work in their profession and will still carry student debt far into middle age.

The overhang of consumer debt and the capture of government by wealth — the government's determination to protect creditors even if it destroys the economy for the rest of us — are the reasons most of us have never recovered from the recession of 2007-08. These are the causes, ultimately, that produced the last Donald Trump and will certainly bring the next one to center stage.

If our policy of radically protecting creditors doesn't change soon, we may never escape the trap of fake populism. Proposals like this one offer hope, and a real way out.
  

Hospitals-- A Place People Go To Get Even Sicker?

I'm sure many people think of hospitals as places to go to be cured of sickness. I always think of hospitals as places to go to die. And not just to die because medicine doesn't cure much of anything but die because hospitals all filled with disease so that patients who go to them are at risk of catching something unrelated to whatever brought them there in the first place-- and dying. Does that sound crazy?

Thursday Reuters published a report from London that over 3 million Europeans come down with just such an infection in a hospital every year! That's 80,000 people a day, every day. And some of these infections are fatal or can take months of expensive and intense treatment to overcome. One in 18 patients in any given hospital at any given time has something he acquired in the hospital. "Healthcare-associated infections pose a major public health problem and a threat to European patients," said Marc Sprenger, director of the Stockholm-based European Centre for Diseases Prevention and Control (ECDC).

The most common types of infection are respiratory tract infections such as pneumonia and infections of the bloodstream. These are often caused by Klebsiella pneumonia and E. coli bacteria, both of which have shown an ability to develop resistance to some of the most powerful antibiotics.

Among a total 15,000 reported healthcare-associated infections, surgical site infections and urinary tract infections are also common. Many of the infections are also found to be drug-resistant "superbugs," the survey showed.

Among all infections with Staphylococcus aureus bacteria in which full testing was carried out, more than 40 percent were reported as resistant to methicillin-- in other words they were MRSA infections, the ECDC said.

Worldwide, MRSA infects an estimated 53 million people annually and costs more than $20 billion a year to treat. It kills around 20,000 people a year in the United States and a similar number in Europe.

EU health and consumer affairs commissioner Paola Testori Coggi said the findings of the European survey were "worrying" and urged health authorities to do more to protect patients in hospital and to step up the fight against antibiotic resistance.

Drug resistance is driven by the misuse and overuse of antibiotics, which encourages bacteria to develop new ways of overcoming them.

Experts say hospitals are often guilty of overusing antibiotics, giving them as "blanket" treatments before full testing has established which drugs are really needed.

That tendency to over-use antibiotics is even worse among American doctors. In fact in the U.S. hospital-acquired infections cost over $25 billion a year. A report from CBS News last month pointed out that one of the problems with hospital-acquired infection is not just that they can be deadly, they can also take a long time to diagnose. American doctors are hopelessly bad, notoriously so, at diagnosing anything that they didn't learn about in Med School.

One of the major problems is that bacteria found in hospitals has been evolving for generations. These organisms are subjected to antibiotics and disinfectants constantly, so those that survive are considered superbugs.

"These hospital-acquired infections are typically driven by bacteria, and bacteria are living organisms," Accelerate Diagnostics CEO Lawrence Mehren said on CBS This Morning: Saturday. "Like all living organisms, they try to survive and bacteria living in hospitals are living in a high threat environment."

Mehren says that you should not blame the institutions, that they are in fact very clean and that it is really about the biology of the bacteria.

Accelerate Diagnostics, a Tucson, Ariz., biotech firm, has come up with a way to more quickly diagnose these organisms for quicker treatment options. The firm developed a non-cultured testing for the rapid identification of drug-resistant organisms and hospital-acquired infections.

Thursday, the Toronto Star looked at some ways hospitals have been fighting back against this plague, beyond just washing your hands, which is what most older doctors tell you to do.

Progress is being made by hospitals to prevent infections from all causes and specifically from superbugs. You can always ask about a hospital’s infection rate, both overall and within each department. You also can ask about the technology used to avoid infections. Here’s what’s new and tried-and-true.

There’s ever-improving older technology. Ultraviolet (UV) germicidal technology continues to be upgraded and is used for sterilizing operating rooms, air ducts, hospital equipment, hallways and patient rooms. And steam/vacuum sterilization (by autoclaving for instruments) and the use of germicides are effective.

New stuff includes robotlike devices that can clean a room by dispersing hydrogen peroxide into the air and then detoxifying it. Some hospitals say this can reduce a patient’s chances of becoming infected with drug-resistant bacterial strains of vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile by 80 per cent.

Lastly there’s what we call the “all-hands-on-deck” approach, combining the latest technological solutions with standard cleaning.

Dr. Mike’s Cleveland Clinic has been a leader in achieving hand hygiene-- the single most effective front-line defence against infection in hospitals. The national average for hand-hygiene compliance in hospitals is less than 50 per cent. An extensive education campaign and the addition of hand-hygiene monitors improved the compliance rate at the Cleveland Clinic to greater than 98 per cent.

Can you imagine yourself insisting that the doctor-- and the nurses-- wash their hands before touching you?

You And I And Prostate Cancer

When I retired from Warner Bros a few years ago I was relatively young-- still in my fifties-- with everything in the world to look forward to. In fact, when I first took the job at Warner Bros many years earlier, I had retirement in mind. I had run my own indie record label in San Francisco and managed to get by on between $5,000 and $10,000 per year. And I never felt poor or in any way envious of what other people had. I felt very much on top of the world-- it just wasn't a very commercialized world. When I moved from San Francisco to Los Angeles to take the job at Warner Bros, my salary shot up from $10,000 to $95,000 overnight. That's more than my dad had ever made. That's more than I had ever imagined making. I figured I could work 2 years-- 3 at the tops-- save every cent and retire to a beach for the rest of my life. But it wasn't long before there was another zero on that figure... and beyond.

I bought a big house in a "nice" neighborhood, very different from my railroad flat in the Mission District (before the Mission District became gentrified). Warners made me get rid of my Mercury Comet and I wound up with fancy cars. I had to buy clothes... and things. I didn't retire.

And one day I woke up and thought, now's the time: retire. I wouldn't be able to buy my own plane, but I'd be ok unless I lived longer than anyone in the history of my family. And then, just as I was packing it in, my doctor told me I had prostate cancer. So much for the worries about outliving my savings. My father had died of prostate cancer. Actually, he didn't. He died from the treatment he got to save him from prostate cancer. A lot of people do. And in the statistics, I soon learned, those deaths don' count as deaths from prostate cancer.

But long before I was learning, I was panicked, which was how most people feel when they get that kind of a "death sentence." My doctor, gently pushed me towards surgery, although he asked me to read a book he gave me so I could make an informed decision about which kind of treatment. The urologist he introduced me too-- "the biggest in L.A.; and the stars and all the doctors use him"-- insisted on surgery. He was a surgeon, I soon learned. He was an asshole as well. I hated everything about him. But all the alternatives were abysmal. They guaranteed a miserable, brutish retirement, as you can see in the video above. In fact the head of radiology at Cedar Sinai had persuaded me to go for radiology (seed implantation) instead. When I mentioned that radiology had killed my father, she said, "Oh, we didn't know a thing about it back then. We've come so far." But that was what my dad's radiologist had told him, more or less.

And then I met Dr. Tim Brantley who taught me how to heal myself. I'm a chapter in his book, The Cure: Heal Your Body, Save Your Life. I had already come to the conclusion from the book my "regular" doctor had given me that a last chapter, "Watchful Waiting" (he didn't know that chapter was in the book) would be the best thing for me. And Tim's treatment-- change in lifestyle and diet mostly-- was "Watchful Waiting" on steroids. I lost sixty pounds, built a swimming pool so I could swim everyday, cut out the worst poisons in the American diet, like sugar and... well it's about 8 years later and I feel more healthy than I did any time I was working at Warner Bros.

And my conclusions about Medicine, Inc being all wrong with their approach? Medicine, Inc. has now come to the same conclusions. Too late for my dad. But not to late for you. Again, watch the video above... and here's a story in the Independent, one the most respected newspapers in England, from this weekend.

Cancer specialists are bracing themselves for publication of a research study that will challenge the way one of the commonest cancers is treated. The world's biggest randomised trial of prostate cancer has found that the standard surgical treatment for the disease is ineffective.

The study compared surgical removal of the prostate gland-- radical prostatectomy-- with "watchful waiting" (doing nothing). The results show that surgery did not extend life. A leading British specialist, who asked not to be named, said: "The only rational response to these results is, when presented with a patient with prostate cancer, to do nothing."

Cancer of the prostate is the commonest male cancer affecting 37,000 men a year in the UK and causing 10,000 deaths.

But in up to 50 per cent of cases it is slow-growing so that patients affected, even when left untreated, can live for many years and die of something else.

Some specialists are beginning to question whether these cases qualify for the label "cancer" at all.
The results of the Prostate Intervention Versus Observation Trial (PIVOT), led by Timothy Wilt and started in 1994 with 731 men, showed that those who underwent the operation had less than a three per cent survival benefit compared with those who had no treatment, after being followed up for 12 years. The difference was not statistically significant and could have arisen by chance.

When the findings were presented at a meeting of the European Association of Urology in Paris in February, attended by 11,000 specialists from around the world, they were greeted with a stunned silence.

One expert who attended the meeting said that while most research results are immediately transmitted by specialists in the audience using social media, "I did not see any urologists enthusiastically tweeting about [this one]."

Prostate cancers are already classified as "tigers" (aggressive) or "pussy cats" (low risk). But some urologists who have spent years training to perform complex surgical techniques find the idea of watchful waiting unacceptable.

Surgery carries a risk of side effects that can have a serious impact on quality of life with 50 per cent of men suffering impotence and 10 per cent incontinence.

According to the NY Times hustlers and clueless doctors are still pushing ineffective-- at best-- treatment. When I asked a friend, a doctor, why those in his profession never consider warning people away from sugar, fast food, and other unhealthy things people eat, he told me that his entire time in medical school-- including advanced degrees for surgery-- included one two-hour lecture on nutrition. One. And yet... "The US National Cancer Institute reports that males who include greater than one third an ounce of chives, garlic, onions and scallions have a greatly reduced risk of developing prostate cancer.

Cathy's entry into a clinical trial on "The Big C" reminds me that we still need to talk about Marcia Angell's NYRB series on treating mental illness

It was a rough episode for both Paul (Oliver Platt) and Cathy (Laura Linney) last night on The Big C.

by Ken

I really loved last night's episode of The Big C, the fourth of the second season, which revolved around the arrival of the long-awaited day of Cathy's first treatment (for her otherwise-untreatable Stage IV melanoma) as part of a clinical drug trial. Probably I should be writing about that, but with all the importance the Jamisons attach to getting Cathy into Dr. Sherman's clinical trial, it has bothered me that so far no mention has been made of the number of people in that trial who are receiving a placebo rather than the drug(s) being tested; is it really possible to do drug trials without a double-blind control group>

Which in turn has reminded me that I still need to write about Marcia Angell's recent two-part series in the New York Review of Books: "The Epidemic of Mental Illness: Why?" (June 23) and "The Illusions of Psychiatry" (July 7).

Now trials for cancer treatment, I hope, at least, have more scientific basis than I now understand trials of drugs for treating mental illnesses to be. In the first part of her NYRB Angell notes:

Nowadays treatment by medical doctors nearly always means psychoactive drugs, that is, drugs that affect the mental state. In fact, most psychiatrists treat only with drugs, and refer patients to psychologists or social workers if they believe psychotherapy is also warranted. The shift from "talk therapy" to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs.

In the second part of her article Angell relates the explosion of reliance on drugs for treating mental illness to a transformation in the practice of psychiatry -- based, she suggests, not on advances in the understanding of mental illness, but on a transformation in the market for mental health treatment:

When psychoactive drugs were first introduced, there was a brief period of optimism in the psychiatric profession, but by the 1970s, optimism gave way to a sense of threat. Serious side effects of the drugs were becoming apparent, and an antipsychiatry movement had taken root, as exemplified by the writings of Thomas Szasz and the movie One Flew Over the Cuckoo’s Nest. There was also growing competition for patients from psychologists and social workers. In addition, psychiatrists were plagued by internal divisions: some embraced the new biological model, some still clung to the Freudian model, and a few saw mental illness as an essentially sane response to an insane world. Moreover, within the larger medical profession, psychiatrists were regarded as something like poor relations; even with their new drugs, they were seen as less scientific than other specialists, and their income was generally lower.

In the late 1970s, the psychiatric profession struck back -- hard. As Robert Whitaker tells it in Anatomy of an Epidemic, the medical director of the American Psychiatric Association (APA), Melvin Sabshin, declared in 1977 that "a vigorous effort to remedicalize psychiatry should be strongly supported," and he launched an all-out media and public relations campaign to do exactly that. Psychiatry had a powerful weapon that its competitors lacked. Since psychiatrists must qualify as MDs, they have the legal authority to write prescriptions. By fully embracing the biological model of mental illness and the use of psychoactive drugs to treat it, psychiatry was able to relegate other mental health care providers to ancillary positions and also to identify itself as a scientific discipline along with the rest of the medical profession. Most important, by emphasizing drug treatment, psychiatry became the darling of the pharmaceutical industry, which soon made its gratitude tangible.

At the time, Angell writes, "The APA was then working on the third edition of the DSM [Diagnostic and Statistical Manual of Mental Disorders], which provides diagnostic criteria for all mental disorders." The DSM is now up to a heavily revised fourth edition, with the fifth famously in the works -- the whole psychiatric community seems to be involved, though actual control of content seems to be safely and securely in the control of eminent personages in the psychiatric industry (it does seem now to have developed into an "industry" rather than a "profession") who are business partners of the pharmaceutical industry, which has come to provide financial support for all aspects of the psychiatric industry.

To return to the first part of Angell's argument, concerning "the epidemic of mental illness and the drugs used to treat it," she takes a highly skeptical look at "the epidemic of mental illness and the drugs used to treat it." Really, you can't judge her argument on the basis of my high-points synopsis. If you believe, as I formerly did, that mental illness is a matter of brain chemistry, and chemistry that we have increasingly come to understand, then you need to read the article.

Some points that really stuck with me:

* There really doesn't seem to be much actual science behind these supposedly scientific claims. To the extent that they have won acceptance, it's largely based on the supposedly demonstrated efficacy of the new generations of brain-affecting drugs.

* But despite the scientific-sounding claims, the drug developers really don't know what their drugs are doing, and the drugs' "efficacy" is, plain and simple, unproved. Angell reminds us that in the development and testing stage drug manufacturers can do as many trials as they like, and then when it comes to submission to the FDA they can include only the trials they wish -- obviously the ones that seem to show drug success. But in cases where it has been possible to get access to all the trials, the success rate is little or even no better than that of the placebos, especially when the placebos are of the "active" variety, meaning that they do something.

* And this was a real eye-opener for me: Angell documents the belief of researchers who seem pretty credible that the determining effect in many drug trials, especially where the results affect the "mind" rather than actual physical symptoms, relate not to successful treatment of symptoms, which is all but impossible to measure, but to the drugs' having side effects. This sounds weird at first, but as Angell unfolds her argument, it makes sense. When patients are expecting, or hoping for, results, drugs that produce side effects give the patients a real physical sense that something is happening. Again, if this draws your attention, you need to read Angell's argument, in the June 23 article, rather than my synopsis.

Crucially, the drug enthusiasts' hypothetical "explanations" for the drugs' therapeutic workings have little or no basis in actual physiological understanding. Especially in the cases of the broad range of mental conditions that have been defined (one is tempted to say "invented") by the people who control the psychiatric definitions, the one thing that seems scientifically true is that the drugs are doing something to the brain, and there seems to be lots of reason to think that these un-understood physiological consequences aren't desirable -- that, in other words, they may in fact be creating mental impairments rather than relieving them.

Which brings us back to that crucial matter of the psychiatric industry has now given its business over to the creation of diagnoses that make virtually everyone who draws breath a candidate to consume, on an indefinite basis, expensive drugs of undemonstrated usefulness, and possible negative effect.

Especially vulnerable are children, whose systems are so much more susceptible to side effects.

What should be of greatest concern for Americans is the astonishing rise in the diagnosis and treatment of mental illness in children, sometimes as young as two years old. These children are often treated with drugs that were never approved by the FDA for use in this age group and have serious side effects.

And a whole industry has developed around matching poor children who may display signs of overactivity or irritability to government funds for drug treatment -- and only drug treatment. "[T]o qualify nearly always requires that applicants, including children, be taking psychoactive drugs. According to a New York Times story, a Rutgers University study found that children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines." Remember too that it is totally legal for doctors prescribe drugs for uses and patients other than those covered by the FDA's certification of efficacy and safety; the drug companies just can't market those off-label uses, but they've become highly proficient at getting other people to do their promotion of unapproved uses for them.

"At the very least," Angell argues,

e need to stop thinking of psychoactive drugs as the best, and often the only, treatment for mental illness or emotional distress. Both psychotherapy and exercise have been shown to be as effective as drugs for depression, and their effects are longer-lasting, but unfortunately, there is no industry to push these alternatives and Americans have come to believe that pills must be more potent. More research is needed to study alternatives to psychoactive drugs, and the results should be included in medical education.

In particular, we need to rethink the care of troubled children. Here the problem is often troubled families in troubled circumstances. Treatment directed at these environmental conditions -- such as one-on-one tutoring to help parents cope or after-school centers for the children -- should be studied and compared with drug treatment. In the long run, such alternatives would probably be less expensive. Our reliance on psychoactive drugs, seemingly for all of life’s discontents, tends to close off other options. In view of the risks and questionable long-term effectiveness of drugs, we need to do better. Above all, we should remember the time-honored medical dictum: first, do no harm (primum non nocere).

UPDATE: BACK FROM HIGHBRIDGE PARK

Except for the autumn foliage, this was very much our first view of the High Bridge approaching from the south on the path along the upper edge of Coogan's Bluff overlooking the Harlem River in Highbridge Park.

In case anyone is wondering, I've just made it home from the Highbridge Park hike with Prof. Sidney Horenstein which I wrote about in my post last night. I've added a brief update there.

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What would it take to give us health care that isn't programmed by the medical-industrial complex?

Mad As Hell Doctors plans a Sept. 8 cross-country

caravan to DC for single-payer health care.

"The fault, dear Brutus, is not in our stars,
But in ourselves, that we are underlings."

-- Cassius (to Brutus), in Julius Caesar (Act I, Scene 2)

by Noah

Earlier today, I was listening to a broadcast of a town hall meeting that was held by Ed Schultz on Friday night in Portland, Oregon. Through a friend who recently moved there, and from listening to Thom Hartmann’s radio show, which is based there, I had heard that Portland was a pretty progressive city. Still, I was taken aback and very pleased to hear how much the sold-out crowd was so very in favor of single-payer health care, the concept of health care that dare not speak its name in Washington, DC. This support of single payer is also what the majority of people that I know here in New York are also expressing.

Many, many months ago, I asked my doctor what he felt about the health care issue. I was careful not to let on where I was coming from. If we were going to discuss this, he had to go first. I wasn’t about to irritate the man who has the box of latex gloves. To my pleasant surprise, he answered, “Single-payer is the only way out of the mess we’re all in, but I know that whatever we get from Washington won’t be that, and it will be a complete fiasco.”

My doctor is a prophetic man. Too bad that cretin from Montana Max Baucus, chairman of the Senate Finance Committee, didn’t want to hear from him or anyone else who had the firsthand knowledge and war stories that my doctor, so many other doctors, and their patients have and will continue to have when the shit hits the fan like an asteroid hitting from space.

One of the people who attended Ed Schultz’s town hall in Portland was a doctor who announced to all present that he and four other Portland doctors had just formed an activist organization called Mad As Hell Doctors (www.madashelldoctors.com). To quote the website:

You CAN handle the truth.

There’s no nice way to say it. The financial cost of health care is killing our citizens, hobbling our economy, crushing small business, and threatening the solvency of our government. In the meantime, the health care industry is spending almost two million dollars a day lobbying Congress and manipulating public opinion to accept “reform” legislation that leaves a vicious, for profit system intact.

I recommend that you read the whole page at the site. It’s not long. The doctors also mention that, in a bit of activist theater, they are forming a caravan from Portland to Washington, DC, in September. They hope for a very long caravan, and I wish them well, but we seem to live in a very passive age. Perhaps we are just numb to it all by now. Still, I would love to see hoards of RVs, trucks, buses, and cars descend on the nation’s capital. My god, how would our government get to work and do the people’s business if the whole city was one big gridlocked traffic jam?

Not to worry, the people’s business, as we know all too well, is the last thing on the tiny little minds in DC (Dirtbag Central).

Mad As Hell goes on to call the so-called public option a trap. To some that may seem harsh. I personally never expected single-payer out of the inside the Beltway creeps, but I did, perhaps naively, hope for something that would soon lead to single-payer. I have always been realistic about how the people who are supposed to be our representatives don’t really give a damn, but if the whole health care debate has shown this country and the world anything, it is just how hugely corrupt and bribed up the lowlifes in Congress are, especially those in the Senate. Maybe long-term that will be a good thing, but right now we just might be getting that trap that Mad As Hell refers to.

For a long time I have worried that we were being sold one idea of a public option while the dirtbag crowd fully intended it to be a public option in name only. What really confirmed this for me was watching a senator from my state, one Chuck Schumer, sit on his increasingly fat ass and say nothing while Max Baucus got all hissy and furiously banged his woefully and pathetically undersized gavel and arrested those who showed up to contribute their experiences and knowledge to his precious hearings. Schumer just sat there with his smirk firmly in place. It was only when his constituents reacted and made it clear that they wanted a public option if they weren’t getting single-payer that Schumer belatedly said that of course he too wanted “the public option.” Not only that, he said, he had always wanted “the public option.”

Now why wouldn’t I trust this man? When the Mad As Hell doctors say the public option is a trap, they don’t mean what it could and should be, they mean the version that the totally corrupt Senate has in mind: a public option that is so tied up in such a maze of subsidies for the medical-industrial complex -- premium shell games, “flexible” deductibles, and the like -- that it is completely castrated.

I increasingly suspect that we have been rope-a-doped by the kings of sleaze. It started with the refusal to even mention single-payer. Yes, we were never going to get it out of these living, breathing turds, but it should have been our sacrifice in the war of compromise. We would have then reluctantly seen single-payer get watered down into a public option. Instead, the starting point was the public option, so what we now have is Obama’s anti-public-option consigliere, Rahm Emanuel, giving the secret hand signals to Congress which basically say, “It’s OK to collect money from the K Street bribery squads and stick the knife in the public option. We’ll end up with more money than the Vatican for the next four election cycles.” Think of the whole health care reform debate as one big ugly fund-raiser.

Right now the words “public option” get mentioned less and less. In their place is South Dakota Sen. Kent Conrad’s pull-the-wool-over-their-eyes scenario that goes by the name of "coops," a concept that not only has already proved disastrous in places like Oregon but calls for continued control by the insurance companies. Same thing, different name -- so what? Screw you, Conrad! But he knows and expects that too few will be paying attention.

Ideas like the single-payer caravan that Mad As Hell is attempting on September 8 represent a pushback against Washington’s business-as-usual. It’s coming in the form of an increased number of voices in favor of single-payer. Part of it is in anger and frustration. Part of it is, no doubt, the result of increased awareness of the definitions of terms and the details of what is going on and what could be if we had responsible government. But, as Mad As Hell says:

The “public option” is doomed.

First: We will have a dysfunctional health care system designed around insurance companies. Second: It will be impossible to cover everyone without raising taxes. The Obama administration is already saying it is acceptable to leave out 15 million people. Which 15 million? Will you be one of them? Who gets to decide? Third: In a “post-option” environment you can bet that the health insurance industry will manipulate the rules so that the sickest and most expensive patients will gravitate toward the public plan, which will cause it to fail. When it does, the opponents of real reform will point to the “public option” and scream: “See! Single Payer won’t work!”

Obviously, if we repeal the Bush tax cuts for the top two percent, we can pay for a real public option, one with teeth. Right now, however, the cost issue is being used as a prime scare tactic by opponents of reform both in Washington and in the media, and low-information voters are buying into it.

As for the medical-industrial complex manipulating the rules: Of course they will. They already do it. You think they will stop? You think there won’t be loopholes put in just for them? They already turn you down for all sorts of fine-print things, often under a euphemistic catchall called “preexisting conditions,” which amounts to a "get out of jail free-of-paying" card for insurance companies. You pay for years, and when you make a claim, only then do they investigate your entire medical history, looking for a reason to deny your claim. At that point they have years of your payments in their vault. With today’s data bases, seeing your complete history is getting easier for them every day. When you filled out that form years ago, did you mention that acne episode you had at age 14? The stitches in your knee at 15? The mild concussion from your first car accident? Technicalities-R-Us.

THE ANTI-REFORMERS ARE ON
THE OFFENSIVE. IT SHOULD BE US!

Those who want true reform are not being heard due to a willful disconnect between the bribe spongers who write our laws that dictate policy and the huge majority of the voters. I started this post with a quote from a play about a government that thought it was more important than its country and people. I’ve always liked to think of Julius Caesar as a morality play. “Beware the ides of March” and all that. Maybe we should put on a presentation of Julius Caesar on the mall in front of the Capitol building when the lowlifes return from their recess. My version, though, would substitute the name of a different senator every day in place of old dead Julius. And the guys who did the deed would be ordinary folks. You bunch of Caesar wannabes; This could be you! Come on out and watch. Naw, they wouldn’t get it anyway.

Remember when South Carolina Sen. Jim DeMint boasted a couple of weeks ago that the members of the House and Senate would go home for the August recess and come back afraid to vote for health care reform after they received an earful from their constituents? I have to think that he knew what was coming and was referring to what I saw on the MSNBC shows this Monday night: Town halls held by members of Congress that were interrupted by crowds of thuggish, belligerent, shouting hooligans advised (programmed), supported, and transported there by arms of the medical-industrial complex.

Among these arms is former House Majority Leader Dick Armey’s lobbying firm, Freedom Works, which also organized those fab "tea party" demonstrations a couple of months ago. They want to make sure that our so-called representatives do not hear from the majority who want reform. They aim to stop health care reform, and even stop talk of health care reform. They are using mob intimidation, not unlike how a certain group got its start in Germany back in the late 1920s, or more recently a group assaulted election officials as they tried to recount the Florida votes in 2000.

While wimpy President Obama goes all Clintony on us and talks of bipartisanship in a misguided attempt to be liked by everyone, the anti-reform mob makes it clear just what folly any talk of bipartisanship and appeasement is. To say the least, there is no point in even trying to be bipartisan.

But, as we know, it’s not just Repugs. Plenty of Blue Dog Dems are involved. To our government, though, it is us who are lowly dogs. To them, we should just gratefully wag our tails for whatever crumbs they might give us. I see no mere coincidence that the mobs who are disrupting civil discourse are organized and paid for by the same people and kinds of lobbying firms that pay off our senators and congresscreeps. It’s all part and parcel of the same thing. It's the medical-industrial complex doubling up on its efforts to persuade the government that absolutely no one wants reform.

On top of all of this, please keep in mind that these Repugs and Blue Dogs are the same cretins who pocketed cash from corporate Amerika and then voted to have the jobs of so many Americans shipped overseas right out from under them. When that happened, Americans not only lost their jobs, they lost their health insurance. Many of those people were sentenced to death for lack of health care while our Congress, many of whose members won their seats and all the perks that came with them by running on a platform of "change," prefers the status quo of just keeping it like it is, with the cash rolling in for them.

They’ll even rail against government-run health care while they and their families enjoy the benefits of the government health program they themselves are enrolled in. If they don’t like it so much, maybe they should give it up. They won’t, of course. They intend on living way past age 62, the age at which they can go on an even better government-run health care system: the very-much-like-single-payer Medicare program.

“Thou call’dst me dog before thou hadst a cause;
But, since I am a dog, beware my fangs."

-- Shylock (to Antonio), in The Merchant of Venice (III,3)

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