The Good, the Bad and the Ugly of Health Care Reform

by Billy Wharton

A simple question for the tea baggers. Where is the socialism now? Frenetic right-wingers spent a good part of the summer shouting about the “government takeover of health care,” or the “stealth socialist health care plan.” Now that the “Affordable Healthcare for America Act” has been passed by a slim margin in the House of Representatives, there are few traces of anything even resembling socialism. Instead, Americans will find the good, the bad and the ugly of healthcare reform all contained within the 1,990 page bill.

The Good
The longer a rotten system lasts, the more any change to it is perceived to be a giant leap forward. In this light, the House health bill contains some positive changes. Insurers will now be prevented from refusing enrollment based on a pre-existing condition or dropping subscribers who become ill. Such policies have allowed private insurers to maintain profit margins and, consequently, are contributing factors to the swelling ranks of the uninsured. Their elimination is certainly a positive reform.

Another provision in the bill removes the anti-trust exemption for private health insurers. Since 1945, insurers have been exempt from Federal anti-trust law but subject to whatever state-by-state provisions existed. Insurers argued that this allowed them to share essential information about pools of subscribers in order to determine risk. In practice, much more than information was shared. The American Medical Association reports that large insurers now control 94% of health care business in most regional markets. A few large-scale private insurers lord over each segment of the country. House Democrats view anti-trust law enforcement as a means to combat this concentration, but it presents a more ominous prospect when viewed inside of the rest of the reform proposal.

Transforming the mass number of uninsured, at last count around 48 million, into potential customers will favor those companies capable of operating economies of scale. In other words, the larger the corporation, the easier it will be to price your way into the new market. For a time, prices may drop, but only at the cost of further monopolization, this time on the national instead of regional scale. Anti-trust law is a notoriously weak weapon to break up monopolies, since enforcement is contingent on the political appetite of whatever administration directs politics in Washington. Removing the exemption is positive, yet creating the conditions to expand the problem of monopolization seems to neutralize the benefits.

The Bad
Many emotional pleas and an equally large number of words have been delivered for and against the public option. Right-wingers point to it as the crux of the secret socialist plan, while honest liberals made it a litmus test for the utility of the bill. What emerged from the debate is a watered-down version of a public plan sabotaged by concessions made to a vocal right-wing and paid for by campaign contributions to Democrats from the private insurance lobby.

Key to the watering-down was de-linking reimbursement rates from the Medicare schedule. Medicare operates as a price-fixed program where rates are negotiated into annual budgets through the legislature. These are, generally, significantly below rates in the private sector. The House bill version of the public plan will operate with rates determined by the marketplace. This means that the private sector will play a primary role in determining the cost structure in which the public plan will operate. This will end the deflationary effect a Medicare-compensation structure would have and may also mean, as the Congressional Budget Office has argued, that a public plan will be forced to offer more expensive plans than private insurers.

The weak public plan will have negative ripple effects inside the overall reform. The uninsured who can prove financial need, can now apply for “insurance credits” to purchase coverage. However, since the public plan may prove to be more expensive than private plans, it is likely that a significant amount of public subsidies will be funneled into the coffers of private health insurers. This fits with a larger pattern being developed by the Obama administration of funneling good public money into bad private sector businesses that have failed to meet the needs of the American people. The double problems of price inflation inside the plan and the issuance of insurance credits to private companies threaten to drive the already inflated price tag for the reform well past the estimated $1.2 trillion.

The Ugly
In another act of right-wing slight-of-hand, House Democrats shifted the mandate burden from the business community onto individuals. Republican pressure forced the ceiling on businesses mandated to provide insurance to their employees up to $500,000 in payroll. This will allow a significant swath of the businesses to be relieved of the burden of purchasing insurance.

Conversely, individuals will be forced by the government to carry some sort of health insurance. The penalty for not doing so will be a fine of 2.5% of your income. Continued non-payment and remaining uninsured will result in further fines and a possible jail term. This is a bonanza for private insurers, as millions will be forced into a new market for low-cost health insurance. Such plans are sure to skimp on coverage and run high on costs.

The site of the herding will be the new health insurance exchanges. This idea, championed by the conservative Heritage Foundation, will insure that market-based ideology frames the new health care system. Rates will be determined here, insurance offerings will be made and terms of care will be formulated here. All this with the continued logic of the marketplace where profits are a central concern and people’s health an afterthought.

Still Single-Payer
None of the changes outlined above amount to socialism. Nor do they even signal the opening of a road which could lead to a socialist health care plan. The hope for genuine reform rests in the same place as it did before the bill was passed – in the certainty that the private sector will make such a mess of health care that the American people will be outraged enough to move towards socializing health care. A single-payer plan would cut across the good, the bad and ugly of this round of health care reform. Our health would cease to be a commodity and be guaranteed as a human right. Plenty of organizing is needed to win single-payer and, in the immediate term, we have plenty of myths to dispel about the wonders of small reforms.

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Note: The opinions expressed in this article are those of the author and do not reflect the positions of the NYC Local of the Socialist Party USA. Comments and questions can be directed to author at: billyspnyc(at)yahoo.com

ACORN: A Flesh-Eating Machine or Left–Wing Conspiracy?

by Billy Wharton

The People Shall Rule: ACORN, Community Organizing, and the Struggle for Economic Justice
Robert Fisher, ed., Vanderbilt University Press (2009), $27.95

A flesh eating machine? A political animal? Or a far-left conspiracy? Descriptions of ACORN vary widely, yet Robert Fisher’s The People Shall Rule attempts to offer readers a window into America’s most influential community organization. The volume brings together academics and activists in what is presented as the first comprehensive examination of the group. Overall, the articles suggest that ACORN has managed to transcend many of the theoretical debates – community development v. conflict politics, service v. advocacy, movement-building v. organizational formation – which have framed previous examinations of community organizing. ACORN, it seems, is a hybrid organization – as willing to employ direct action as to accept donations from real estate magnates.

Several authors point to ACORN’s federated structure as key to the organization’s success. ACORN has managed to marry a fairly centralized, staff-driven, national organization with relatively autonomous member-controlled local groups. This marriage allows for a synergistic national-local energy which is often beyond the capacities of most locally-bound community organizations. For example, Peter Drier argues that many community groups have scored important victories in the struggle to secure community reinvestment programs. Yet, “…only ACORN has used its federal structure to bundle these accomplishments to build its political clout, organizational funding, and constituency base.”

Political clout is precisely what Wade Rathke, founder of ACORN, desired at the group’s origin. Even early on, Rathke argues, the group was “not willing to simply be a power broker,” but, instead, wished to build power in numbers for both street protest and electoral campaigning. In addition, he sought to move away from the “episodic and situational” character of social movements. “Movement,” he stated firmly, “is not magic as much as muscle powering imagination and will.” The basic rule employed to cultivate these muscles is that “if it builds power, if it adds to the whole, then it can be done.” Rathke’s ACORN is a “real-life, flesh eating machine that must be fed constantly on activity and victory.”

The need for constant activity is reflected in ACORN’s stance as an explicitly anti-idelogicial organization in the tradition of Saul Alinsky. They must, therefore, constantly develop new campaigns inside of often hostile historical and economic contexts. One key campaigning opportunity was the struggle against credit redlining in low-income communities, which developed after the Community Reinvestment Act was passed in 1977. Weak national enforcement opened the space for community organizing. ACORN’s versatility was on full display in anti-redlining campaigns – serious research and political lobbying was buttressed by locally-mobilized direct actions. Success was evident on all levels – the organization grew and the campaign generated more than $4 trillion in new loans for traditionally underserved communities.

The victory against redlining was the result not only of organizing from below, but an adaptation by financial capital from above. Capital, it seemed, also had the capacity to respond to changing economic situations. ACORN was therefore faced, in the 1990s, with a social problem it helped usher in by loosening credit – predatory lending in poor communities. Gregory Chadwick and Jan Chadwick estimate that this practice cost victimized families more than $9.1 billion per year and led to countless bankruptcies and foreclosures. ACORN initiated another cycle of organizing that has moderated the predatory trends, but has yet to eliminate them.

Neoliberalism has placed other challenges before ACORN. Another case study presented by John Atlas in his chapter entitled “The Battle of Brooklyn,” describes an organization at a turning point. Atlas describes the struggles surrounding a mega-development project proposed in Brooklyn called the Atlantic Yards project. Real estate magnate Bruce Ratner authored the project and managed to secure significant concessions from NY City and State governments using eminent domain laws to displace residents. Community opposition developed immediately, resulting in the creation of the Develop Don’t Destroy Brooklyn coalition and dissent from prominent Democratic Party officials.

Though they seemed like a perfect fit for the opposition, ACORN’s New York leader, Bertha Lewis, did not head to the picket line, preferring, instead, the negotiating table with Ratner. “It’s better to win something,” Lewis told the media, “than go into opposition and just yell and scream and ultimately lose.” Atlas concurs, viewing the ACORN-Ratner deal, which secured 50% affordable apartments and a portion of living wage jobs, a successful attempt to “steer gentrification to benefit poor and working-class residents.” Opponents called the deal an opportunistic “sell-out” and pointed to large-scale personal contributions made by Ratner to ACORN.

The struggle around the Atlantic Yards development is not an isolated instance of controversy. ACORN has faced multiple internal and external scandals of late. In 2008, newspapers reported that the national leadership was rocked by an embezzlement scandal initiated by a member of Rathke’s family, which led to wholesale resignations, including the founder himself. ACORN veteran Gary Delgado viewed the controversy as evidence of the hazards of bureaucratization on the national level. More recently, undercover right-wing operatives created a national media sensation by soliciting information about concealing funds from an illegal prostitution ring. The stunt manipulated the autonomy of ACORN’s local organizations and has led to a significant national decrease in funding from government sources. Yet, as Robert Fischer argues in the conclusion of this compilation, the sheer scale of the ACORN project provides it with “…the ability to experiment and fail.”

The critiques mentioned above are, however, not as readily available in The People Shall Rule as one would prefer. Most of the authors are exceedingly friendly to ACORN – defending them from either liberal political leanings or as a theoretical wedge in sociological debates about community organization and social mobilization. The book would be improved by providing space to both right and left wing criticisms of ACORN. From the left, significant questions should be raised about the organization’s trajectory. Its willingness to adapt to and, in the case of both Atlantic Yards and H&R Block, partner with capitalist corporations raises questions about how closely the organization is integrated into the structures of neoliberal capitalism. In addition, ACORN’s blind commitment to act as insiders in the Democratic Party is one of many trends serving to stifle the development of significant third party politics in the US.

Overall though, The People Shall Rule is an important first offering into what promises to be a proliferation of studies into one of the most significant community organizations in the country. Left-wing activists of all stripes would do well to understand the manner in which ACORN has harnessed a dynamic tension between local and national organizing to carve out a place in the lives of poor and working class communities. As neo-liberalism moves into what appears to be a period of prolonged crisis, the strategies and structures championed by ACORN offer lessons to be both learned and unlearned.

For more on the People Shall Rule visit Vanderbilt University Press

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Billy Wharton is the editor of The Socialist and the Socialist WebZine. His articles have recently appeared in the Washington Post, Monthly Review Webzine and The Indypendent.

Year One in the House that Neoliberalism Built: The New Yankee Stadium

by Billy Wharton

The beginning of the baseball playoffs offers the perfect opportunity to examine what has been a momentous season in the Bronx. Derek Jeter has become the clubs’all-time hits leader, C.C. Sabathia fell painfully short of a 20-win season and the Bronx Bombers returned to the postseason after a one-year hiatus. All this in a new stadium that has seemed like more of a challenge to fans and community residents than visiting teams to the Yankees. So, as the regular season ends, it is fitting that we mark year one in the “House that Neo-Liberalism built.”

Neo-liberal values of law-and-order and social discipline are the name of the game in the new stadium. This system of top-down control works well in total institutions such as jails, psychiatric wards and concentration camps, but is less effective, and certainly less just, inside of a democratic society. In the baseball stadium, the crowd rules. Spontaneous affinity and the cultivation of a collective will are organic features of a baseball crowd. Thousands of people bound together by voluntary association attempting to will their team toward victory. Raucous cheering, open hostility to the opponent and even the occasional brawl between fans all serve to seal the social pact of fandom.

Organized against these democratic impulses are the forces of the market backed by the muscle of security. For many Yankee Stadium officials, the game is little more than an opportunity to encourage hyper-consumption. Over-policing ensures that the independent impulses of fans are tamed. From the minute one steps into the new Yankee Stadium, they are searched, prodded and cajoled into buying things, experiencing things and being awed by the lifestyle available to rich elites. It is difficult to resist the postmodern prescription that the New Yankee Stadium is some hyperreal spectacle. One can see the dirty fingerprints of the same neo-liberal planning which has mucked up much of our planet all over the new stadium.

Eviscerating the Indigenous
No neoliberal project would be complete without dispossessing the indigenous. Not surprisingly then, the construction of the new Yankee Stadium is a tale of community dispossession, the siphoning of state resources and sharp price increases. For decades now, Yankees officials have held the impoverished South Bronx community where the stadium is located hostage by cooking up far-fetched escape schemes for New Jersey or Midtown Manhattan. Each demand was designed to extract further concessions from the City government. Mayor Michael Bloomberg feigned resistance to the Yankees most recent proposal, while secretly attempting to forge an agreement for a free corporate suit from the Yankees. No corporate seats for Bloomberg, but the Yankees did walk away with up to $700 million in tax payer funds, including $27 million to tear down the old stadium. The community paid an even higher price.

Green space was the first community casualty. The site of the new stadium was the large, high-use Macombs Dam Park, a public park frequented by youth sports teams. Youth baseball in the park created a fitting backdrop to the old Yankee Stadium – the hopes and dreams of the youth ball field emanated out into its professional counterpart. Macombs Dam Park was a vital open space in a neighborhood dominated by massive court houses, a sports stadium and high-rise apartments. The community protested, but their elected officials did not, preferring the political expediency of agreeing with City Hall and Yankee officials. Vague, and as yet unfulfilled, promises to replace the park were issued.

Community organizers with the 4DSBxCoalition have recently launched a campaign demanding that the Yankees deliver on the promise of green community space and other parts of the Community Benefits Agreement. Yet the only remnant of this promise that remains is a map just outside of the stadium which indicates how space will be used after the demolition of the old stadium. The location of the replacement community green space? The roofs of a dozen parking garages for Yankees fans.

Fans of the Yankees have also been swindled. Seats in the stadium are fewer and more expensive. Field-level seat prices were raised as high as $2,500 per game. Displaced fans clinging to seats passed through generations were dispersed to the nether regions of the new stadium. Other fans were priced-out entirely.

Once the season began, the new pricing scheme revealed the stark class contradictions of the stadium. Corporations and rich individuals gobbled up premium tickets, yet often neglected to actually attend the game. Fans, jammed into every other crevice of the stadium, were justifiably enraged at the site of hundreds of empty field-level seats, each section guarded by security. They had unknowingly identified the very essence of neoliberalism. Scarce space could be purchased, reserved and protected regardless of whether the rich actually intend to use it. All utility – in both stadium seating and community green space - had been annihilated.

Cornucopia of Distractions
Strangeness multiplies immediately upon entering the new stadium. As a child on summer vacation, I often wondered why the Amish put their sense of moral purity ahead of the appeals of modern society. Walking into the main hallway of the new Yankee Stadium allowed me to confront everything that is wrong with consumer society. A horse drawn buggy would be preferable to the blaring images of the 1977 World Series. A slice of shoo-fly pie to the massively expensive Yankees Steak House or Sushi Restaurant.

Everywhere a fan turns in the new Yankee Stadium there is some kind of slickly designed distraction, each with only the slimmest connection to the actual baseball game. A stuffed monkey with a Yankees jersey, innumerable cups, mugs, jars, waste baskets with Yankee logos, even a Yankee swim tube. A seemingly endless supply of overpriced souvenir items melds with a bizarre assemblage of food – sushi, pulled pork, kettle korn - to form a blurry consumerist psychedelia wholly divorced from the human activity about get underway on the field.

Contradictions abound. For instance, whatever noble currency is built up by the new Yankees museum is abruptly negated by the fire-sale of history underway in the main hall. The private company Steiner Sports operates a stand in the hall which offers pieces of the old Yankee Stadium for sale. Piece-by-piece, seat-by-seat, and blade-by-blade of grass offered up for a cash payment. The right-field wall, $2,500. Two chairs from the upper deck, $1,500. A clump of grass, $150. Derek Jeter’s locker was sold by Steiner for a reported $100,000. Perhaps only an Amish-informed sense of transcending worldly desires can save a baseball fan from this brutal orgy of commercialism.

The Philadelphia Problem
The stadium also confronts fans with a Philadelphia problem. What makes the new (2004) Citizen’s Bank Park in Philadelphia so striking is not the variety of concessions nor its obscenely homer-obsessed dimensions, but its openness. A fan feels invited into the open spaces of Citizen’s Bank. The space allows the crowd to casually congregate and watch the game from a variety of perspectives. Fans flow through the stadium relatively freely and naturally.

Key to creating this environment is the design of the main seating decks. The upper deck is foisted on a platform underneath which there is a large hallway. The hall is lined with the usual assemblage of souvenir shops, food stands and bathrooms. The innovation is that the stadium designers installed standing room spaces just above the lower deck. There is a small shelf where fans can place food or drinks or even just lean on, while watching the game standing up. There are no tickets here. People freely associate; moving fluidly from their standing spot back to their seats. Conversations develop quite easily in the standing-room seats.

The new Yankee Stadium appropriated this design from Citizen’s Bank. However, a combination of greed and paranoia about freedom of movement motivated the Yankees to privatize the standing room seats. Metal barriers are installed in front of the lower deck and seat numbers assigned to each standing location.

Of course, the Citizen’s Bank designers understood a bit more about the natural flow of the crowd. On a recent trip, I observed dozens of Yankee fans moving toward the standing-room locations. Each one was turned away by one of the hundreds of private security guards employed to police space. The weary security guard explained, perhaps for the millionth time, that the location required a ticket for admission. As a result, any number of fans stood lurching, some on tippy-toes, over the metal barrier attempting to catch a view of the game. Frustrated, they eventually moved back to their assigned seat. So much for Philadelphia freedom.

Freedom or an Interesting Illusion
The stadium is flooded with security guards. Each aisle in each section is guarded by someone – most often a fairly bored mid-20s African-American male who has clearly been instructed to stand with his back to the field and not watch the game. The mental torment of security guards is only one, unintentional, outcome of the policing strategy at the New Yankee Stadium.

What the guards are, in fact, protecting fans from is other fans. The obvious motive for restricting fan movement is to insure the class privilege of the denizens of the field-level seats. However, this was the policy even at the old stadium. The new security policy extends the logic built to protect rich fans to all parts of the ballpark. No one, regardless of the price of their ticket, can move. You must produce a ticket when attempting to enter any section of the stadium. It is total lock down.

Such heavy policing serves to curb all sorts of movement including the formerly venerated “7th inning rush.” Around the 7th inning of a blowout game, hordes of people would descend from the upper decks into lower section seats for a rare close-up look at their baseball heroes. Nothing formalized, just a part of the moral economy of a sports stadium. A temporary reversal of privilege in the baseball world order. Any fan attempting this today would be immediately pounced upon by an army of security guards.

The security policy goes deeper than just quelling this kind of stadium mini-insurrection. It seeks the micro-enforcement of rule of law in the stadium by force – actual force or the public display of the potential to use force. This process is intended to curtail the creativity, self-organization and disorderly chaos that made Yankee Stadium such a wonderful, and dangerous and exciting place to see a baseball game. Fans can no longer freely circulate – possession of a ticket is the sole item which legitimizes movement. In the end, micro-policing in the stadium reflects broader policing trends in society. Similarly, people’s freedom is often exchanged for a few trinkets or an interesting illusion.

Another Path for Baseball? Society?
Baseball is a beautiful game. For much of American history it served as a marvelous escape from the humdrum of work and family. Unlike most other sports there is no time clock in baseball. Hope, therefore, truly springs eternal on the ball field – a team can always come from behind and win, no matter what the score. Fans can play a necessary emotional role in such moments. Perhaps, when the time comes to inspect our society in search of democratic foundations, the essence of what is good about baseball can be reborn.

The new Yankee Stadium is designed to negate this essential goodness. Born with the original sin of community dispossession, the stadium is an over-policed, commercial happy zone which just happens to host 81 baseball games a year. So, for now, at the baseball stadium, as well as in society, we struggle against neoliberal attempts to control where we move, what we consume and how we experience happiness. Essential to such resistance is retaining the spirit of unruliness inherent in the baseball crowd. Doing so may allow us to transform the new Yankee Stadium from a site for neoliberal discipline into a target for a democratically informed non-compliance movement. In the process, we may just save a sport which has brought happiness to millions.

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Billy Wharton is the co-chair of the Socialist Party USA and editor of The Socialist and the Socialist WebZine. His articles have recently appeared in the Washington Post, the Indypendent, Dissident Voice and the Monthly Review Zine.

Rite-Aid Parking Lot a Case for Eminent Domain

by Billy Wharton
from Examiner.com

On a busy Tuesday afternoon, a furious competition is underway on the streets of Pelham Bay. Drivers frantically slip into recently vacant parking spots, cut each other off to be next in line and gleefully toss quarters into public meters. The parking police cruise the block, electronic devices of punishment in hand, ready to dish out a $75 ticket to time or space violators. Meanwhile on the corner of Roberts and Crosby, at the epicenter of the parking contest, fourteen spots in a twenty-one spot parking lot remain empty. An ominous sign promising towing or wheel boots protects this private property and ensures that if parking were declared a competitive sport, Pelham Bay would be its Mecca.

The parking lot is the property of the local Rite-Aid pharmacy chain. Rite-Aid has stepped up its enforcement of parking rules lately, waging a public campaign against wayward drivers. The most high-profile victim came this summer as an elderly man who wandered across the street to retrieve a cup of coffee, returned to discover that his car had been towed. Nearly each day one person or another faces a boot or a tow, all courtesy of the friendly management of Rite-Aid.

For some, this is a simple case of following the rules. Rite-Aid owns the parking lot and, therefore, has the right to determine its rules of use. Yet, for the more civic minded among us, the parking problem in the neighborhood raises important, and perhaps even urgent, questions about how space is used. If the Rite-Aid lot is under-used, perhaps it is time to make it public.

The process for doing so is called eminent domain. New Yorkers familiar with this term may recognize that it has a decidedly negative connotation. Most often, eminent domain is used as a tool by real estate developers to employ the city government to seize the property of private individuals, as part of multi-million dollar development schemes. While this is indeed true, there is also a progressive potential to eminent domain. The idea behind the policy is that if the city can demonstrate that a particular piece of property can be better used if administered publicly, they have the right to seize the space while providing an acceptable level of compensation to its owner.

City officials, especially during the Bloomberg administration, are often in the pocket of real estate developers and jump through legal hoops to argue that blockbuster real estate deals are made in the public good. The Rite-Aid parking lot case is much more simple. The community needs parking spots. A private entity controls twenty one of them. Private control has led to under-use and is contributing to social problems. The space should, therefore, be made public.

Making the parking lot public would serve the interests of the vast majority of people. Local businesses might see an increase in shoppers, shoppers would spend less time competing for spots and local residents could park in the lot overnight. In the longer term, the community might think of other less obvious ways to employ eminent domain. We could take the concept back from the developers and use it for the people. Ensuring all along that it is a bit easier to get a cup of joe.

Documentary Rails at “Stupid” Health Care System

by Billy Wharton
from Examiner.com

Few punches are pulled in California Newsreels’ documentary adaptation of Maggie Mahar’s 2006 investigative book Money Driven Medicine. This physician-centered film exposes the infrequently examined ways in which a privately controlled health care system impinges on the relationship between doctor and patient. As Dr. Andrey Espinoza argues in the film, there are many entities in the examination room besides the patient and the doctor – private insurers and employers often shape the type and amount of care that is delivered.

One of the important offerings in Money Driven Medicine is a clear timeline of the development of the private health care system in the United States (US). The first key moment comes after World War II as many other nations shift to public insurance and publicly controlled delivery of care. In the US, doctors played a key role in preventing the creation of such a public system by asserting their right to determine care. But this physician-centered care was displaced in the 1970s with the rise of Health Management Organizations. “M.D.’s,” Mahar states, “were traded in for MBA’s.” As this business-centered system failed in the 1990’s, private insurers tried to reign in costs by denying costly, but often medically necessary, medical procedures. Backlash ensued and since the late 90s, insurers have liberally approved procedures while jacking up premiums to defend their profit margins. Costs have skyrocketed.

The result is a bloated health care system which rewards specialists who perform multiple procedures instead those who provide good preventive care. A critical assessment is, therefore, offered about the myth that America has the best health care in the world. When it comes to what Donald Berwick of the Institute for Healthcare Improvement, calls “rescue-care” the system performs quite well, but what most people need is open access to simple preventative care. Here Berwick argues, “We are nowhere near the best and it is reflected in outcomes.” The health care system in US pays for doing things not healing patients.

In fact, as studies conducted by the Dartmouth Institute prove, doing more has little impact on positive outcomes. High-treatment states such as New Jersey, which spends 20% more than the average for Medicaid, have equal or worse outcomes than low-treatment states such as Iowa. Physician interviewees in the movie spoke openly about a health system that has been commodified, industrially produced and, finally, is not designed to improve people’s health.

This leads to the second key argument in Money Driven Medicine. The problem with health care is not just lack of insurance; it is an overall lack of access to the kind of care people need. The fee-structure described above has consequences that have filtered down to the training of doctors resulting in a scarcity of primary care physicians. Medical student Krystal Irizarry called primary care, “A burden compensation wise.” Consequently, the film presents multiple patients who have no “medical-home” – no single primary care physician - and are reduced to emergency room visits when minor conditions turn into chronic illnesses.

It is no wonder then, that Mahar found plenty of willing subjects for her study. Five out of six doctors she solicited responded. Most described a health care system slipping out of their control. This idea is brought home powerfully when Dr. James Weinstein describes the story of his daughter Brianna who was afflicted with childhood leukemia. After multiple protocols of chemotherapy, Weinstein objected to continued treatment – viewing the proposed cure as more damaging than the disease. Brianna’s doctors insisted on continuing treatment and threatened Weinstein with a lawsuit if he resisted. The doctors in this case feared a costly lawsuit. The result? Multiple, and ultimately futile, treatments which had no medical justification other than avoiding litigation.

The experience allowed Weinstein to realize that most doctors are not really trained to provide useful information to their patients. What’s needed, the film then argues, is a shift to a more unmediated relationship between doctors and patients. As Weinstein and Berwick and others emphasize, such a relationship need not be unbalanced – with physicians lording over patients. Berwick points to studies which indicate that when provided with the proper medical information, patients tend to make more efficient and frugal choices about their health care. Removing profit-motive from medicine will allow doctors to act like doctors – to place their ethical commitment to patients ahead of bottom-line calculations – and patients to make informed decisions.

Some reservations can be noted about the film. Mahar is an investigative journalist who relied primarily on interviews with medical practitioners to piece together her narrative. Some of the history presented in the film could use a broader contextualization. For instance, the post World War II turn away from a public system occurred, not coincidentally, with an intense witch-hunting of socialists and communists. Aspiring politicians such as Ronald Reagan made great currency as both anti-communist hunters and as spokesmen against socialized medicine. Similarly the 1970’s pivot toward HMOs occurred in a moment of transition for Corporate America away from the post-war production model and toward a neo-liberal strategy of lean wages and slim benefits. These broader developments informed changes in the health care industry.


Ultimately, Money Driven Medicine offers perspectives essential for Americans evaluating proposals for health care reform. As stated in the film, the goal is not to tinker with this or that part of the market system, but to totally re-think the relationship between doctor and patient that has developed under a privately owned system. Undoubtedly, although the film does not state this explicitly, a single-payer national healthcare system offers to best hope for reclaiming the doctor-patient relationship. Unfortunately, the trajectory of the health care debate in Washington seems to be bending more toward the tinkering side. Money-driven medicine in America may be able to survive another attempt at reform.

Money Driven Medicine can be purchased from California Newsreel.

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Billy Wharton is the editor of The Socialist and the Socialist WebZine. His articles have recently appeared in the Washington Post, Monthly Review Webzine and The Indypendent

Health Care Activists Arrested at Aetna

by Billy Wharton
from Examiner.com

Nineteen health care activists were arrested this morning after a conducting a sit-in at the offices of the health insurance company Aetna. The protesters demanded that Aetna officials immediately approve all procedures which were recommended by physicians. Denial of medically necessary care is a key strategy employed by private health insurance companies in order to enhance profits. More than 20,000 people die each year from medically treatable illnesses. The nineteen were taken into custody after chanting "Aetna Profits, People Die! Medicare for All!"

Aetna was singled out as a target for civil disobedience since its CEO Ronald A. Williams has been an outspoken opponent of publicly-funded health care reform. When asked about the possibility of creating a public health system during a recent appearance on PBS's News Hour, Williams responded that "it's the wrong way to go." "We think," he continued while be asked about mandating that people purchase insurance, "that having additional customers is a good thing for the industry." Little surprise here since Williams collected more than $40 million in compensation in 2007 alone.

Protesters today were asking for more than just the "public-option" supported by some liberal Democrats. They call for Medicare for all, a single-payer system which would eliminate private insurance companies. A bill in the House of Representatives sponsored by John Conyers, H.R. 676, would accomplish this. Supporters point to the elimination of unnecessary advertising budgets, the end denied claims and universal medical coverage as key elements of a single-payer system.

Despite these benefits, single-payer has received little discussion during the recent health care reform debates. Campaign contributions and insider health insurance lobbyists have been mobilized to silence any discussion of HR676. Today's protest is a part of a national campaign which seeks to bring single-payer back on the table by mobilizing grassroots support.

Constancia ‘Dinky’ Romily, 68, a retired nurse from the East Village summarized her motivations just before being taken away by the New York Police Department, “I’m putting myself on the line and getting arrested to end insurance abuse and win health care for all."

Bronx Traffic Triangle Offers Chance for 9/11 Reconciliation

by Billy Wharton

Sometime soon a traffic triangle in the North Bronx will be renamed in honor of 9/11 rescue worker Dominick Pezzulo. The renaming, the Bronx Times Reporter tells us, is the culmination of campaign to commemorate the Port Authority officer’s bravery. The triangle is located across from Lehman High School, where Pezzulo previously worked as a well-regarded body shop and special education teacher. Bronx Democratic Councilman Jimmy Vacca spoke publicly in support of the proposal at a recent commemoration ceremony.

Pezzulo’s story mirrors many of the tales of courage which have emerged out of the tragedy of the terrorist bombings of September 11, 2001. He and his fellow Port Authority officers answered a call to assist the fallen at Ground Zero. Pezzulo entered the damaged South Tower of the Word Trade Center, but was trapped under debris as the structure began to collapse upon itself. Undeterred, the officer fired off his weapon to alert rescuers to his location. The move saved the life of a fellow rescuer, but Pezzulo perished.

The renaming proposal offers a good example of a different, more positive, way to commemorate 9/11. Instead of emphasizing hatred or a desire for retaliation, recognizing the sacrifice of Dominick Pezzulo places emphasis on the positive values of courage and self-sacrifice. Pezzulo’s act sends a clear message about the preciousness of human life.

Perhaps we can take this humanist impulse further. Unwinding the damage done by September 11th also requires Americans to look at the violence sponsored by the US government in the aftermath of this day and in the name of the American people. Dominick Pezzulo was a victim, yet his death was used not to encourage Americans to have courage, but as a pretext to a military invasion and occupation that has produced more than a million human deaths.

What I propose is that we transform 9/11 ceremonies into events with positive values, by coupling them with recognition of the damage done in its aftermath. I think that Wissam Abed deserves a place next to Dominick Pezzulo. Abed was a 40 year-old computer engineer who lived in the southern port city of Basra in Iraq. On April 5, 2003, his house was bombed and destroyed by the US Air Force – collateral damage in an attack on a Bath Party official. Abed’s mother was killed along with seventeen other people including his sister and a one year-old child.

Dominick Pezzulo is not responsible for the death of Wissam Abed and his family. Pezzulo’s lesson about humanist self-sacrifice was negated by the military adventures of George W. Bush. By taking responsibility for Abed’s death, by using the bravery of Pezzulo as a means to recognize and apologize for a crime committed in the name of the American people, we can all take a serious step towards the creation of a more peaceful society. So, perhaps one day, when America is prepared to move on from the politics of hatred and fear, we will see the Abed-Pezzulo traffic triangle here in the North Bronx.

Pro-War Bronx Democrats Signal Need to Change September 11th Ceremonies

How does a society remember things? Certainly public ceremonies, commemorations and rituals do the important job of keeping moments in history alive in the present. Think, for instance, of how two critical events in American history - the American Revolution and the War of 1812 - are remembered. One receives annual national attention each July 4th while the other barely warrants a sentence in a high school social studies book. Often times the need to remember in particular ways is intensified in societies which have experienced deep social traumas. This is particularly true for Americans who are still struggling to deal with the meaning of the events of September 11, 2001. Commemorations of the day often range from somber ceremonies to pro-war speech making.

A small ceremony held at Jacobi Hospital in the Northeast Bronx this year offers an example of the negative politics still present in many official September 11th ceremonies. The account in the September 17th edition of the Bronx Times Reporter describes a mostly solemn affair. The central act was a wreath and flower laying at a monument to residents of the Bronx killed in the terrorist bombing. Poems as well as “inspirational messages” were read and a choir sang the national anthem.
Yet, the political side of the event was punctuated by abrasive speeches whose language harkens back to the darkest moments of the post-9/11 regime of George W. Bush. Assemblyman Michael Benedetto (D) attempted to open a space to explore the “strange mixture of emotions,” brought on by the now yearly event. He included sadness, pride, hatred and love. Noticeably absent was a desire for reconciliation or even a yearning for a more peaceful world.

Assemblywoman Naomi Rivera (D) attempted to order these jumbled emotions with a bit of patriotic fervor by asserting to participants that “this is also a day to be proud to be Americans.” Why? “Because we,” she claimed, “are not going down without a fight.” Rivera attempted, in only one sentence, to bridge the gap between past and present. September 11, 2001 was suddenly linked, in a positive way, to the current military occupations of Iraq and Afghanistan. Benedetto and Rivera’s comments signal that the Democratic Party, once dedicated to denouncing “Bush’s folly,” is now fully willing to carry forward the military adventures initiated by their Republican adversaries.

The problem is that most Americans know by now that the fight initiated by the Bush regime and carried forward by President Barack Obama, is a false one. Remember? No WMD’s. No Osama. Just a “shock and awe” campaign which destroyed a modern society and triggered bloody divisions between Shite and Sunni. Afghanistan may even be worse as Obama continues to pour troops in and many return in body bags with no end in sight for hostilities. Think of the tragic loss of a mother like Cindy Sheehan. Why should this make Americans proud? Why should we be forced to link 9/11 and military occupations?

Some Americans have refused to maintain the false connection between the post-9/11 wars and the terrorist attacks themselves. A survivors group calling themselves the September 11th Families for Peaceful Tomorrows has done an intrepid job of attempting replace hatred with solidarity and dialogue between Americans and people in the Middle East. They have built upon the teachings of Dr. Martin Luther King who, when speaking of Vietnam, advised that “Wars are poor chisels for carving out peaceful tomorrows.” By emphasizing common values and a common sense of humanity, these Sept. 11th families have signaled a desire to move away from the vision put forward by Assemblywoman Rivera. The actively oppose the wars and call for the immediate removal of troops.

Now, some eight years after the great tragedy of 9/11, it may finally be time to change the content of our yearly commemorations. A first step is to recognize that holidays, customs and traditions are all human inventions. Their tone and points of emphasis can change over time as the will and needs of the society change. In the case of 9/11, the responsibility of American citizens is to do what we can to both commemorate the human loss of September 11, 2001 while building the political will to end the wars in Iraq and Afghanistan. September 11th should be a day of peace and reconciliation not war and hatred.