Good Video on Covid-19

Public Easily Swayed by Framing of Healthcare Debate

A fascinating poll by the Kaiser Family Foundation found that information and framing play a huge rule in support for and opposition to the Affordable Care Act (aka Obamacare). For example, support for the “individual mandate,” or requirement that all Americans buy health insurance is one of the least popular measures within the bill (only garnering 35 percent support). But when respondents learn that most Americans are already covered by employer-sponsored plans, that support swells to 62 percent. On the other hand, if the question is framed within the context of people being forced to purchase insurance “they find too expensive or don’t want,” the opposition rises from 64 to 79 percent. Not surprisingly, a year into the Act, a majority of Americans also are unaware of many of its provisions (particularly those who still don’t have insurance). As just two examples, nearly 40 percent of respondents believe it provides financial support for illegal immigrants to get insurance (it doesn’t) and more than 40 percent still believe in the absurdly-fictional “death panels.”

It is but the latest example of how a society that pays more attention to the lives of complete strangers than their representatives has allowed the country to be taken over by corporate and elite interests. Cynicism is a disease that eats at the very fabric of democracy, feeding on ignorance and a lack of hope. Many mistake this cynicism for apathy, claiming people just don’t care anymore. But I don’t believe that. I think what has happened instead is that people across the political spectrum have become so disillusioned by the sense that our democracy is broken that they largely or completely disengage from the process, only to act every two to four years based on limited and often flawed information. The first step in overcoming this pandemic of cynicism is to restore that hope and find ways to frame politics and difficult policy issues in ways that the public can understand and that can garner support. If progressives continue their snarky and elitist panning of all those that disagree with them instead, they are essentially serving the very forces they claim to oppose.

Why is there no Ebola cure?

Ebola was first discovered all the way back in 1976 and has been part of the public imaginary since the publication of The Hot Zone by Richard Preston in 1994. There have been 26 outbreaks so far, with the largest until now costing 224 deaths (of 425 infections) in Uganda in 2000-1. We are obviously currently experiencing the deadliest outbreak in the history of disease ravaging Western Africa as usual, but spreading to Spain and the U.S., already counting 9,286 incidents and 4,597 fatalities. Yet in those nearly four decades, no drug has been approved to treat the horrifyingly deadly hemorrhagic disease. Why?

The answer is both obvious and rather disturbing – profit margins. Pharmaceutical companies deciding where to spend their research and development funding generally look at the potential for future revenue streams. And curing or treating diseases in the Global South (developing and underdeveloped countries in Africa, Southeast Asia and parts of South America) is just not as profitable as palliatives for Western diseases and conditions or, at the extreme, making up things like “General Anxiety Disorder” and “Restless Leg Syndrome” so they can sell even more treatment. In fact, the pharmaceutical industry made a rather disturbing discovery in the late 70s – it is substantially more profitable to treat the symptoms of a condition (palliative) than to actually cure diseases. And thus the explosion of anti-depressants, EDD drugs a decade later, ADHD treatment (essentially speed) and the like.  New diseases? Just not as profitable, including new more potent antibiotics to treat the growing strains of drug-resistant microbes. And while the government has partially or wholly funded many of the most important patents in the industry for the past 50 years, they appear to have little power to actually influence what the companies do or how much they ultimately charge for the drugs they do create that actually save lives.

Diseases that strike the poorer countries thus receive almost no attention at all. Beyond Ebola, malaria and tuberculosis (which kill a combined 2 million people a year) receive less attention than high cholesterol, Chagas, dengue and other “neglected tropical diseases (which affect a billion people and kill as many as 500k) have 10 marketed drugs of the over 15,000 that came to market between 75 and today. And the same is the case in the West, with more drugs targeted toward the middle and upper class, male over female treatment, and white over minority conditions. One could argue that this is the natural way that the market works, but is it a just, or even intelligent, approach to healthcare?

Diseases like Ebola bring this issue into the public eye and arguably provide an opportunity for a broader debate about the pharmaceutical industry and its priorities and near monopoly over life on the planet. Unfortunately, in the contemporary media moment, we are more likely to hear the Obama administration somehow blamed for the minor outbreak (and, given sufficient time, maybe for the disease itself (as a young Muslim visiting Africa)).  But forgoing the bigger issue for a moment, what can be done to stem a disease that could kill millions? Do we simply accept that a pandemic could ravage human populations not only in the poorest countries but across the globe? Do we hope the CDC can control the growing dangers of rare diseases showing up inside our borders, given the continued expansion of globalization? Or can national government or international bodies find a way to push companies to find a cure? Two possibilities exist to address this troubling situation: 1. Subsidize research into potential cures or 2. Create a competition. It turns out, the later is the better option, as long as the competition is perceived as fair and the rewards are large enough to create sufficient incentive. (The New Yorker).

Let’s hope the U.S. government and global bodies start to create these incentive programs, not only for Ebola but for all of the biggest healtcare issues facing humanity today. Don’t hold your breath … or maybe, do!

Healthcare Enrollment Up; Uninsured Percent Down

See article here: Wonk Wire

Healthcare Tango

So a growing number of Democrats are pushing Senate Majority Leader Harry Reid to include the public option in the reconciliation bill, that can bypass a Republican filibuster. Reid is waiting to count votes before he decides, as is House leader Pelosi. In the meantime, Obama is backpedaling yet again, offering a modified plan that he hopes some Republicans will support: www.nytimes.com/2010/02/19/health/policy/19health.html?pagewanted=print. The reasonable party, however, doesn't really need to see one to decide that "no" is their answer: tpmdc.talkingpointsmemo.com/2010/02/cantor-we-will-say-no-to-the-health-care-bill.php. So those most interested in the debate decided to actually ask people what they think: www.tonic.com/article/health-care-reform-bill-activists-poll-states-on-public-opinion. Early leaked results show a plurality supporting a bypass of the obstructionist Republicans, while 51% remain unsure (in Illinois). It's time for the feckless Democrats to finally get some backbone and take a chance. Poll after poll has shown that passing healthcare will have little to no effect on their prospects for November. Why not do something radical that could alter the future of the country? We will see if Democrats stand for anything other than supporting Wall Street and backpedaling every time they get close to taking a stand on anything . . .

Lobbying and Democracy

Some facts from Harper's Index this month:

# of registered drug-company lobbyists in DC for every member of Congress: 2
Average amount spent on Congressional lobyying, per day, by healthcare cos.: $1,500,000
Average amount the U.S. government spends on each child during first 18-years: $140,000

Is there something wrong with these numbers? As with the banks, companies are paying extraordinary amounts of money so they can drain more money out of your pockets. Of course they are scared of the government -- they have the power to make healthcare a public good, like it is in the rest of the world. The definition of a public good is one that is not owned privately, mainly because the social benefits and externalities are so great it is not well served by normal market function. Huh, might healthcare fit that definition? Could there be both individual, family and larger social good from a healthier population with more money to spend on other goods? Um . . .

Healthcare Reform or Conservative Revanchism?

The healthcare debate has, in many ways, taken on a relatively surreal tone in the past few months (Obama as a socialist, fascist Hitler-like figure, the healthcare reform somehow leading to a tragedy worse than the Holocaust, the bill allowing the government to decide when people live and die, etc.), but it seems as if the Catholic Church has taken the debate to a new level of inanity. So healthcare reform was supposed to be a movement forward to insure those who are uninsured, to cut costs and to reign in the excesses of hospitals, insurers, pharmaceutical companies and others involved in the “industry.” To progressives, it was offered as a way to free people and improve our quality of life. That was until “progressive” Nancy Pelosi decided to heed the warning of Catholic bishops and include a provision that disallows coverage for abortions. Even worse, it prohibits any health plan that seeks federal subsidies from offering abortion coverage. Huh? Last time I checked, abortion was legal in America. So if they can’t win the battle in the courts, or in the ballot box, use a backhanded deal in Congress to undermine a women’s right to chose.

Essentially a potentially huge progressive victory will all but outlaw abortion in America. Women can supposedly buy supplemental coverage for abortion, but isn’t that a stigmatized solution to the problem that will give many women (and particularly young girls) pause? Can the young even get coverage for abortion, given that they are on their parents plan? What of poor women, who might not be able to afford the additional coverage? And how can a rider like that be legal, given the reality (again) that ABORTION IS LEGAL IN AMERICA. Whatever your position on the matter, it is hypocrisy to allow that people should be free to do what they want as long as they don’t do what you don’t want them to. Why are we allowing the government to step in and take control of women’s bodies? And does this make the bill a progressive, or conservative, triumph if it does eventually pass in the Senate? Even with a huge victory in the election a year ago, the Democrats again show that they have the backbone of jellyfish.

http://www.google.com/hostednews/ap/article/ALeqM5i-CXZID-rNNxiUfAE2wP4oUU1ZLAD9BT71980

Healthcare "Debate"

Good article in Salon on the healthcare debate: http://www.salon.com/opinion/feature/2009/09/24/healthcare/print.html. While the public continues to support the public option and hungers for real reform, the heathcare industry and the politicians they have bought pretend they are representing them. This is backed by a punditocracy that seems to parrot the discourse of the far right as if it spoke for all Americans. Will the media ever change? Is there such a thing as responsible journalism any more? Too many on television ignore the real public climate in lieu of the very "special interests" they decry. Instead of the reporters who once fought for the public interest, we have too many who are part of the elite. The only hope exists on the margins and we can only hope they have a strong enough voice in the mainstream.

Healthcare Debates: The Cost of Neoliberalism

A new today poll from USA Today shows the potential perils in one of the underlying tenets of neoliberalism (http://www.usatoday.com/news/washington/2009-08-10-healthcarepoll_N.htm). The idea is that acting in our own self-interest leads to the best outcome for all. This has always been a fallacy outside purely economic terms (and sometimes within in), but healthcare brings the problem into focus in a way that few other issues do. Healthcare has social costs and benefits that transcend the individual. This is particularly true given the incredible power that healthcare providers hold – essentially the power to directly or indirectly affect the quality of your life; and more seriously it’s length. Making decisions primarily based on one’s own interests, undermine the ability to address the two biggest problems today – costs and the uninsured. In the long run, the uninsured cost all of society, but neoliberal ideology, and American society in general, have a hard time looking to the long run. And the only way to control costs is to act collectively -- as shown most clearly by the fact that the power to control costs come predominantly from the number insured within a particular group.

As debates continue and fear becomes a key factor, it appears the aging population of the U.S. is predominantly making decisions based on their own interests – in the poll as the sample participants get older, they are more interested in controlling costs than dealing with the uninsured. Among 18-29 year olds, we do see more worried about the uninsured than cost containment. But every other group believes controlling costs is more important (with the percentage increasing as the cohorts age). There is also a race dynamic here, as 75% of Blacks and 66% of Latino/as believe we should expand coverage to the uninsured. Left out of so many of these discussions are the people who can’t vote – the millions of children who do not have access to basic healthcare that could very well affect them the rest of their lives. And the group most opposed to healthcare reform are the elderly.

Healthcare and education are really public goods, with huge externalities that the market is often unable to capture. These externalities are both positive and negative. A healthy society has lower medical costs and thus a workforce that can increase productivity and reduce shared social costs. A well-educated public provides more high skill workers and a more vibrant democracy that can challenge its problems through informed, diversified participation in the public sphere. Without effective healthcare and educational systems a country can easily fall into debt and long-term decline. This is also the case with the environment, with the middle class and rich the only one’s generally able to make ecologically responsible decisions. It is also the case with the corporate world, where more and more make decisions that benefit themselves but hurt others – not because they are “bad apples” but because we have set up a system where profit maximization trumps social responsibility and the common good. The U.S. is currently on a path where the privatization of public goods could send us into a hinterland from which we will not recover. Can we convince people to think beyond their self-interest, recognizing that in the end it is in their self-interest to think collectively about key public goods?

Healthcare Debates: The Government Wants to Kill You

On the McLaughlin Group this morning (http://www.mclaughlin.com/), a microcosm of the problems with the current healthcare debate came into clear focus. Conservative Pat Buchanon, who has gotten more reasonable on some matters, was speaking of how Democrats want to assist seniors in suicide or, at its extreme, euthanasia. Monica Crowley was herself chiming in, using our collective fear of government intervention into our lives, warning that bureaucrats are suddenly going to start telling people how to end their lives. Other conservatives have started to call Obama a Nazi or Fascist, lied about the cost and are now showing up at the town hall meetings with their absurd comparison (http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080603854.html). Is there truth in these claims?

The reality appears to be that the government will pay for people to go visit their doctors to discuss their end of life options (including a living will). Why would the Medicare pay for these services? Because, among other things, 24% of the total lifetime costs of Medicare occur in the last year of people’s lives. In other words, hospitals, hospices, drug companies, and the like are making a fortune on that last year of our lives . . . often not by making it better, but by running up bills that do little to improve the quality or length of that life. The second reality is that healthcare costs are now $1.7 trillion a year and rising, which translates to 17% of GDP. That is unsustainable in the long run. And lest us forget, as I have mentioned before, that obesity and the aging of the population over all (remember those pesky baby boomers that are retiring as we speak) are on the rise and thus costs will only balloon further in the future.

Healthcare is big business in America though, and a real role for the government will undermine their profitability. So lobbyists are spending millions, conservative talk show hosts come up with absurd analogies, wingnut operatives disrupt town hall meetings and the entire conservative establishment and its corporate benefactors spread misinformation and fear to undermine necessary reform. We don’t hear of the 30% of pharmaceutical company revenue that goes to advertising, or the shift to palliatives (from curatives) that occurred in the 70s. We hear lies about the healthcare systems in Canada and England, but very little about the even better systems in Scandinavia. And rather than reasonable debate, the mainstream media largely plays along – failing to give people the facts that could help them make informed decisions. Some of these facts include the fact that we have among the lowest life expectancy and higher infant mortality rates of any industrialized country in the world. Aren’t these two pretty big indicators of how good the healthcare system in a country is? And how about the fact that a majority of the population are on some drug or another, even though many of these drugs do little to improve our lives? ADHD only became a national endemic when there were drugs to deal with it. General Anxiety Disorder, Uncomfortable Leg Syndrome, Adult ADD, anti-depressants for children, Phen Phen, Hormone therapy for women, etc., all show how profitability influences healthcare decisions in a negative way. And yet few seem to bring all the pieces together and ask the really important questions. They start the conversation and then it degrades down to what we are witnessing now (http://www.salon.com/news/feature/2009/08/06/healthcare/print.html).

I think it is interesting to consider the conservative movement today within this context. After the election, there was some blood-letting and many argued that conservatives had to redefine themselves. Instead they seem to believe they should return to the Clinton era strategy – bottleneck Washington, undermine reform, challenge every big policy initiative and use lies and fear-mongering to turn the country against the presidency. The problem is hints are again emerging that this strategy is effective. In a country where many take pride in their ignorance or the stone-like quality of their, often uninformed, opinions, framing debates in this way is very effective. This is particularly true with a mainstream media establishment that has lost its heart and tends to report as if there were no facts to confront the he said-she said nature of debates in the political arena. The big problem is we have serious long term challenges that will go unaddressed if this absurdity continues. Beyond healthcare is the still reeling economy, global warming, retirement costs in the coming years, persistent racial inequalities and ongoing income disparity differentials that undermine democracy itself. If we do not soon address these problems, I believe rumors of the not too distant demise of America might not be so exaggerated . . .

Framing Healthcare: Fear is a Friend of Foes

Republicans, conservative talk radio and even abortion foes have come together to rejuvenate a brilliant idea from none other than the Bush administration. Renaming the inheritance tax as the death tax was a brilliant strategy used a few years ago to end an important aspect of our ideas of American meritocracy. Now they are taking a provision from the new healthcare bill to do a similar thing – use fear as a motivating factor to get the very group that need healthcare reform to oppose it. The so called “death care” provision simply asks doctors to assist patients in making living wills and other preparations for all of our ultimate fate (http://www.washingtonpost.com/wp-dyn/content/article/2009/07/31/AR2009073103148_pf.html). Yet as the powerful have known from time immemorial, besides divide and conquer, fear is one of the greatest motivators.

It was used after 911 to start a war, undermine the constitution and misdirect a growing list of scandals that plagued the administration in the aftermath (remember all those terror alert raises at opportune moments that somehow never materialized in reality)? Now they are using the arsenal that continues to allow them to dominate public discourse and debate. Fear, divide and conquer (see Gates fiasco and Sotomayor hearing), and misinformation are their arms and they trump the still enervated Democrats, that can’t seem to find the needed ganas even in the thrall of a major electoral victory. Can we survive without substantial changes to the healthcare system? What will we do when the baby boomers start retiring in mass? How can we handle the growing obesity pandemic and its enormous long-term health costs? Can profits trump the public interest in perpetuity? Like the environment, these are questions our kids and grandkids will have to answer if conservatives have anything to say about it.