[Ip-health] Health Care in an Age of American Decline

Riaz Tayob riaz.tayob at gmail.com
Wed Apr 18 13:10:21 PDT 2012


[Health Imperialism (abroad) = Health Tyranny @ Home?]

Snip:

*Furthermore, patent-protected pharmaceuticals will sell at premiums with
markups sometimes up to a thousand percent.  It’s often argued that patent
protection and value markup are required in order to fund research and
development.  However, we cannot ignore the costs of advertising,
marketing, lobbying, and profit margins.   The economist Dean Baker has
done significant work in exposing the inefficiencies and deceitful
practices of the pharmaceutical industry that ultimately harshen the
financial burden on the general public (17).  He has argued for several
years that publicly funded research for the development and distribution of
patent-free drugs would be far more advantageous than the current system
that spends an estimated $300 billion per year on prescription drugs.*


April 17, 2012
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 The Hollow Republic


http://www.counterpunch.org/2012/04/17/health-care-in-an-age-of-american-decline/?utm_source=rss&utm_medium=rss&utm_campaign=health-care-in-an-age-of-american-decline
 Health Care in an Age of American Decline
by RAVI KATARI

*“A heart that’s full up like a landfill.  A job that slowly kills you.
Bruises that won’t heal.  You look so tired, unhappy.  Bring down the
government, they don’t speak for us.  I’ll take a quiet life, a handshake
of carbon monoxide.”*

 The existential sorrow in Thom Yorke’s voice has never sounded as poignant
as it does today in “No Surprises”, a track of lonely capitulation on
Radiohead’s monolithic *OK
Computer<http://www.amazon.com/exec/obidos/ASIN/B000002UJQ/counterpunchmaga>
*.  The song evokes images of helplessness and retreat in the face of
globalization and corporate capitalism.  The accompanying music video
features Yorke’s head in a bubble helmet that slowly fills up with water
(1).  The symbolism in both the lyrics and the video has become
increasingly relevant since the record’s release fifteen years ago.

Some call it America in Decline and it’s a theme that has been explored
extensively over the recent years, months, and weeks (2) (3) (4).  The idea
is obviously met with skepticism.  In order to understand it, we have to
put it in perspective and define a context.  What exactly is America and
what’s in decline?

It remains the richest country in the history of modern civilization.  It
controls the most powerful and comparatively advanced military machine ever
assembled: a likely result of spending more than the rest of the world
combined (5).  The two characteristics are intimately related.

Indeed, the idea that the accumulation of wealth inculcates suspicion and
the need to defend it has even been discussed by 6th century philosopher
Boethius in *The Consolation of Philosophy: *“the wealth which was thought
to make a man independent rather puts him in need of further protection”
(6).  In fact, the need for institutional protection of private property is
one of the most heavily explored topics of classical liberalist thought and
framed much of the debate during the United States’ formative period.  We
like to think that the nation was founded on principles of total equality
and personal liberty.  But the chief concern among the framers was how to
create a system where landowners can remain landowners without having to
worry about greedy peasants.

The concept rapidly generalizes to capital accumulation today.  Wealthy and
privileged members of society want the government to perform its intended
function which is to protect their assets.  What would have previously been
labeled agrarian reform is basically equivalent to progressive taxation.
However, any rational politician will cater to privileged interests
especially when legislative positions are virtually bought in the current
system.   The collection of votes is now regarding as a secondary
consequence of properly financing an electoral campaign.

Social reforms that benefit the overwhelming majority of the
population—where political power is least concentrated—are marginal issues
that require populist demonstration in order to enter the political arena.
The civil rights movement, the feminist movement, and the AIDS movement are
just a few examples.  That these were issues that could not be influenced
by voting highlights a particularly sinister illusion of franchise.  We
vote for politicians that seem relatable given their stance on satellite
issues.  Presidential candidates will resort to tactics such as showing up
on MTV discussing underwear in order to the exploit youth culture.  In
other venues he’ll discuss how to be tougher on crime or how to withdraw
from some foreign conflict in some vague number of years.

But where’s the candidate that speaks to immediately relevant issues such
as access to health care or proper retirement benefits?  The former example
is pretty striking, actually.  Government sponsored medical coverage has
been a prominent domestic concern for almost 40 years (7) (8).  Even a
recent 2009 NY Times/CBS News poll suggested that 72% of the population
were in favor of a government administered health insurance program that
would compete with current private plans (9).

Furthermore, there’s no longer any doubt that a public option would
drastically reduce health costs and thus relieving some of the burden on
consumers.  A 2003 study published in the *New England Journal of
Medicine *concluded
that health care administration costs account for 31% of health
expenditures in the U.S. which comes out to almost $300 billion.  Canada’s
administration costs, on the other hand, makes up 16.7% of their total
health expenditures (10).  The high costs of U.S. health administration are
a direct result of having to navigate the extreme complex channels of
billing and reimbursement through private insurers.  As one would expect,
the system’s complexities are tailored to minimize payouts to consumers and
simultaneously maximize profits.

The U.S. has very little to show for its insanely expensive health
arrangement.  Its per capita costs are twice those of other advanced OECD
nations (11).  However, it ranks pretty low in health outcomes such as
infant mortality and and life expectancy (12).

And the burden on the general population is, indeed, quite severe.   Two
landmark 2009 studies by Harvard physicians David Himmelstein and Steffie
Woolhandler were able to show that the extraordinary costs of healthcare
and insurance impose crushing financial burdens and leave many who cannot
afford insurance to die.  They found that 62.1% of bankruptcies filed in
the United States in 2007 had medical causes.  This value is sharply
contrasted with an estimated 8% in 1981 and 46.2% in 2001.  80% of the 2007
figure had health insurance and most were well-educated and middle-class
(13).  Furthermore, the researchers were able to link the lack of health
insurance to 45,000 working-age deaths per year in the U.S. and conclude
that the uninsured are 40% more likely to die than those with private
insurance (14).  This figure, too, is in sharp contrast with a 1993
estimate of 25% (15).  The spectrum of health outcomes parallels
socioeconomic status as one would expect, but the worsening trends and
sheer quantity of deaths are so morally alarming that they cannot be
ignored.

The outlook is even more depressing when we examine a recent U.S. Census
Bureau report which revealed a striking racial distribution of
uninsurance.  21% of blacks and 31% of Hispanics in the U.S. are uninsured
compared to 11.7% of whites (16).  This, too, is not that surprising.  The
proportions are probably similar for those who drive Range Rovers, but we
have to remain cognizant of the fundamental difference between the two
commodities.

The consequences of private administration of healthcare are fairly
predictable.  A corporation’s chief concern will always be self-sustenance
and growth.  Consumer benefit is only a priority when it contributes to the
two main goals.  The touted virtue of free market efficiency is based on
the symbiotic relationship between consumer benefit and corporate profit.
Unfortunately, it’s not really a free market.  The government is
continually prohibited from acting as a significant competitor even though
most of the population agrees that it should be.  Because of the
fundamental difference between health and Range Rovers as commodities,
consumers do not have the option of simply boycotting the product or
choosing a competitor and thereby placing downward pressure on costs.
Saying no to healthcare is simply anti-human.

Furthermore, patent-protected pharmaceuticals will sell at premiums with
markups sometimes up to a thousand percent.  It’s often argued that patent
protection and value markup are required in order to fund research and
development.  However, we cannot ignore the costs of advertising,
marketing, lobbying, and profit margins.   The economist Dean Baker has
done significant work in exposing the inefficiencies and deceitful
practices of the pharmaceutical industry that ultimately harshen the
financial burden on the general public (17).  He has argued for several
years that publicly funded research for the development and distribution of
patent-free drugs would be far more advantageous than the current system
that spends an estimated $300 billion per year on prescription drugs.

The prospects for change are pretty bleak given the virtual
disenfranchisement of the general population which brings us back to
American decline.  Media-propagated illusions are partially responsible.
The current debate surrounding Obamacare is a ripe example.
Government-sponsored insurance is not even on the agenda and the public is
led to believe that the Affordable Care Act and its guaranteed coverage is
the solution we have long waited for.  This illusion is based on the false
dichotomy between Democrats and Republicans.  It’s a bad joke, really.
Obamacare is modeled on the Massachusetts health plan the origins of which
trace back to the Heritage Foundation (18) (19).  It was implemented by
then-Governor Mitt Romney.  I’ll spare the irony.

The bottom line is that the individual mandate would require everyone to
buy in to private insurance risk pools to decrease medical premiums.  It
will funnel hundreds of billions of dollars to private insurers and Big
Pharma and further inflate their political clout.  Even if it passes, an
estimated 23 million of the current 50 million Americans will remain
uninsured (20).  Alternatives such as a single-payer system or at least a
public option are completely missing from the debate even though a majority
of the population is in favor of them.  Of course, with these alternatives,
private insurance companies would stand to lose.  Corporate executives
would lose money and perhaps workers would be laid off, but that overall
human suffering would be less is an obvious conclusion of alternatives that
are marginalized by the media and our politicians.

Thus, the current trend can be visualized as a hollowing out of the
American identity.  The military and financial prowess of the United States
makes it an undeniable juggernaut in the global theater, but it has very
little advantage for most of the population.  Unemployment and healthcare
are the two most pressing concerns for most Americans, but there’s very
little that can be done via the electoral system due to its deeply
financial nature.  Those that do climb the socioeconomic ladder are driven
into virtual fiefdom via debt burdens that are owed in part to the absurd
costs of tuition for higher education (21).  Crushing debt burdens
discourage social activism and inculcate profit-seeking values.  Those that
cannot afford to climb the ladder or choose not to will have to confront
the depressing avenues of uninsurance and poverty which only exacerbates
the vicious cycle of decline.

*Ravi Katari works for a health law firm  in Washington D.C.  He graduated
from the University of Virginia with a degree in Biomedical Engineering. *

Notes.

1)      http://www.youtube.com/watch?v=u5CVsCnxyXg&ob=av3e

2)      http://www.hoover.org/publications/defining-ideas/article/82581

3)
http://www.truthdig.com/report/item/american_decline_debated_contested_obvious_20120410/

4)      http://www.tomdispatch.com/archive/175502/

5)
http://armscontrolcenter.org/policy/securityspending/articles/fy09_dod_request_global/

6)      http://www.gutenberg.org/files/14328/14328-h/14328-h.htm

7)      http://www.kff.org/healthreform/upload/7871.pdf

8)      http://www.fair.org/index.php?page=3633

9)      http://www.nytimes.com/2009/06/21/health/policy/21poll.html

10)   http://www.pnhp.org/publications/nejmadmin.pdf

11)
http://www.commonwealthfund.org/Publications/Issue-Briefs/2011/Jul/US-Health-System-in-Perspective.aspx

12)   http://www.nejm.org/doi/full/10.1056/NEJMp0910064

13)   http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf

14)   http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2008.157685

15)   http://www.ncbi.nlm.nih.gov/pubmed/8336376

16)   http://aspe.hhs.gov/health/reports/2011/CPSHealthIns2011/ib.shtml

17)
http://www.guardian.co.uk/commentisfree/cifamerica/2011/may/31/healthcare-pharmaceuticals-industry

18)
http://www.heritage.org/research/reports/2006/04/the-significance-of-massachusetts-health-reform

19)
http://www.heritage.org/research/reports/2006/07/the-massachusetts-health-plan-lessons-for-the-states

20)
http://pnhp.org/news/2010/march/pro-single-payer-doctors-health-bill-leaves-23-million-uninsured

21)
http://www.usnews.com/education/blogs/student-loan-ranger/2011/09/28/college-tuition-growth-rate-is-biggest-bubble-of-them-all



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