America's Flawed Health Care System Fuels the Opioid Epidemic

I will be honest right up front.  I fully support a single payer health care system that would put healthcare insurance companies as we know them out of business.  Having done legal work for a hospital system and physicians in the past, the former, like health insurers, care only on maximizing profits despite advertisements to the contrary, while the latter are largely restricted in the practices by what health insurers will pay.  Prescribing a pill to mask the symptom is so much cheaper than addressing the true under lying cause.  And, of course, the insurers care nothing about a preventative approach to medicine.  Put all of this in the context of the opioid crisis in America and there's a reason why other advanced industrialized nations are not experiencing a similar crisis: they have universal health care systems that take an entirely different approach to health care.  America's health care system is literally killing tens of thousands of citizens.  A piece in the Washington Post looks at this reality - something that neither Trump or Congressional Republicans will admit, much less address.  Here are article highlights:

For the second year in a row, life expectancy in the United States has dropped.

It is not hard to understand why: In 2016, there was a 21 percent rise in the number of deaths caused by drug overdoses, with opioids causing two-thirds of them. Last year, the opioid epidemic killed 42,000 people, more than died of AIDS in any year at the height of the crisis.

“We should take it very seriously,” Bob Anderson, chief of the Mortality Statistics Branch at the National Center for Health Statistics, told my colleagues Lenny Bernstein and Christopher Ingraham. “If you look at the other developed countries in the world, they’re not seeing this kind of thing. Life expectancy is going up.”

In other words: In no other developed country are people taking and dying from opioids at the rates they are in the United States. We have about 4 percent of the world's population but about 27 percent of the world's drug-overdose deaths.

What explains the discrepancy?  The U.S. medical system.

Americans are prescribed opioids significantly more often than their counterparts in other countries. In the United States, 50,000 opioid doses are taken daily per every million residents. That is nearly 40 percent higher than the rate in Germany and Canada, and double the rate in Austria and Denmark. It is four times higher than in Britain, and six times higher than in France and Portugal.

That is in large part a result of our health insurance structure. Unlike countries that provide universal health care funded by state taxes, the United States has a mostly privatized system of care. And experts say insurers are much more likely to pay for a pill than physical therapy or repeat treatments. “Most insurance, especially for poor people, won't pay for anything but a pill,” Judith Feinberg of the West Virginia University School of Medicine told the BBC.  . . . . the best thing is physical therapy, but no one will pay for that. So doctors get very ready to pull out the prescription pad. . . . . . As a result, Americans were being prescribed opioids. Often, they were given several more pills than they could be expected to use, to avoid repeat visits. 

[D]octors in the United States are much more likely to provide painkillers than are doctors in other countries. One comparative study found that Japanese doctors treated acute pain with opioids about half the time. In the United States, the number was 97 percent of the time.

There are other culprits, too. The United States is one of only two countries that allow prescription drug companies to advertise on television. (The other is New Zealand.) The companies do advertise, a lot. In 2016, pharmaceutical companies spent $6.4 billion on advertising. Experts say, too, that U.S. medical schools have not done enough to educate students on pain management, addiction and opioid use and abuse.

Drug companies also try to woo physicians with gifts. Some companies host fancy dinners, and others sponsor conferences and junkets. In 2016, for example, OxyContin maker Purdue Pharma spent $7 million on gifts to doctors and teaching hospitals. . . . .  In the same period, the company doubled its sales force, distributing coupons so doctors could offer patients 30-day supplies of OxyContin and other highly addictive drugs. In those six years, prescriptions for OxyContin jumped from 670,000 to more than 6 million.

That alarmed at least one public-health group, which ran a 2009 bulletin titled, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy.”  By then, it was too late.

Is Healthcare Reform The Republicans' Waterloo?

There are two factors that Republicans seem unable to grasp as they seek to inflict their reverse Robin Hood agenda on America: (i) many GOP congressional seats are held because of gerrymandering, not because the GOP's policies are overwhelmingly popular, and (ii) Donald Trump won the presidency due to an Electoral College fluke - and the gutlessness of Electors - and overall won the vote of less than 30% of voters.  A third factor that may be also in play is the reality that a majority of Americans want the federal government involved in healthcare.  Indeed some pools suggest that a majority of Americans want a single payer system that would take away the power of health insurance companies that only care about making money and, frankly, do not give a damn abut taking cared their insureds or their insureds' best interest.  If the congressional Republicans had joined in passing Obamacare and been willing to take even more power from insurance companies and pharmaceutical companies, the nation would likely have a much improved and better perform healthcare system.  Instead, Republicans sold their souls to insurance companies and pharmaceutical companies and clung to the myth that the free market could improve coverage and reduce cost.  Anyone honest should concede that what the Republicans harp on even today is simply out of touch with objective reality.  Worse yet, a majority of Americans are catching on to the fact that the currently dead American Health Care Act was really all about give a trillion dollar tax break to corporations and the obscenely wealthy. . 

Conservative writer and columnist David Frum warned Republicans back when Obamacare was first being crafted that GOP obstruction and non-participation would haunt the party.  For his candor and insight, he was refarded by being figuratively ridden out of town on a rail by his Republican brethren. He's back again and once more suggests that healthcare and the public yearning for a well functioning national healthcare system will be the GOP's Waterloo.  He makes the case in a lengthy piece in The Atlantic.  It is a long piece, but worth the read and it shows what conservatism should be. Here are excerpts:

Seven years and three days ago, the House of Representatives grumblingly voted to approve the Senate’s version of the Affordable Care Act.  . . . . Rather than lose the whole thing, the House swallowed hard and accepted a bill that liberals regarded as a giveaway to insurance companies and other interest groups. The finished law proceeded to President Obama for signature on March 23, 2010.

A few minutes after the House vote, I wrote a short blog post for the website I edited in those days. The site had been founded early in 2009 to argue for a more modern and more moderate form of Republicanism. The timing could not have been worse. At precisely the moment we were urging the GOP to march in one direction, the great mass of conservatives and Republicans had turned on the double in the other, toward an ever more wild and even paranoid extremism. 

At that time, I worked at the American Enterprise Institute, the most high-toned of Washington’s conservative think tanks. . . . The mood then was that supporters and opponents of the Obama administration were engaged in a furious battle over whether the United States would remain a capitalist economy at all.

It was no moment for advocates of compromise—indeed, it was precisely because I appreciated its unwelcomeness where I worked that I had launched an independent blog in the first place. There, to the increasing irritation of my colleagues and employers, I fruitlessly argued through 2009 and 2010 that Republicans should do business with President Obama on health-care reform.

It seemed to me that Obama’s adoption of ideas developed at the Heritage Foundation in the early 1990s—and then enacted into state law in Massachusetts by Governor Mitt Romney—offered the best near-term hope to control the federal health-care spending that would otherwise devour the defense budget and force taxes upward. I suggested that universal coverage was a worthy goal, and one that would hugely relieve the anxieties of working-class and middle-class Americans who had suffered so much in the Great Recession. 

[W]hen the Democrats indeed did pass the law without Republican input, just as I’d warned they would, a fury overcame me. Eighteen months of being called a “sellout” will do that to a man, I suppose. I opened my computer and in less than half an hour pounded out the blogpost that would function, more or less, as my suicide note in the organized conservative world.

The post was called “Waterloo.” . . . . Even more provocatively to Republicans already fixed on a promise to repeal the Obamacare abomination, I urged: "No illusions please: This bill will not be repealed." . . . . The next morning came a phone call inviting me to talk things over with AEI’s president. By Thursday, I was an ex-think-tank staffer.

Over the next seven years, Republicans would vote again and again to repeal the Affordable Care Act. Total and permanent opposition to the law would become the absolute touchstone of Republican loyalty. . . . . From time to time, some old veteran would recall my 2010 prediction that the law would endure and smilingly wonder if I wished to reconsider.

I never did, for the reasons that the whole world has witnessed in real time over this week of Obamacare’s 7th anniversary.

Some of the conservatives who voted “no” to the House leadership’s version of repeal may yet imagine that they will have some other opportunity to void the law. They are again deluding themselves. . . . . Too many people benefit from the law—and the Republican alternatives thus far offer too little to compensate for the loss of those benefits.

In that third week in March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage. That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters—and especially by enough Republican voters—to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to “choose” to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.

What happens now is that—a few bitter-enders aside—Republican politicians, especially in the states, begin the slow and belated process of entering the next era of health-care politics. . . . How generous should health coverage be? What should be done to control costs? Who should pay, and on what terms? To what extent should citizens be free to impose the cost of their unhealthy choices upon others? Conservative-minded people will converge on one set of intuitions; progressives on another. It’s possible to imagine a Republican health-care politics that rejects the ultra-redistributionary approach of the ACA and instead argues that since all benefit from health coverage, all must contribute to its costs via some kind of broad-based tax. 

It’s possible to imagine a Republican Party that cares about the details of health policy and is not satisfied with poorly informed hand waves toward outworn party shibboleths. It won’t happen soon, perhaps—but the sooner the better.

Health care may not be a human right, but the lack of universal health coverage in a wealthy democracy is a severe, unjustifiable, and unnecessary human wrong. As Americans lift this worry from their fellow citizens, they’ll discover that they have addressed some other important problems too. They’ll find that they have removed one of the most important barriers to entrepreneurship, because people with bright ideas will fear less to quit the jobs through which they get their health care. They’ll find they have improved the troubled lives of the white working class succumbing at earlier ages from preventable deaths of despair. They’ll find that they have equalized the life chances of Americans of different races. They’ll find that they have discouraged workplace discrimination against women, older Americans, the disabled, and other employees with higher expected health-care costs. They’ll find that their people become less alienated from a country that has overcome at last one of the least attractive manifestations of American exceptionalism—and joined the rest of the civilized world in ameliorating and alleviating our common human vulnerability to illness and pain.

I take no pride or pleasure in saying “I told you so.” . . . . Republicans who were wrong about the evolution of this debate please consider why they were wrong: Consider the destructive effect of ideological conformity, of ignorance of the experience of comparable countries, and of a conservative political culture that incentivizes intransigence, radicalism, and anger over prudence, moderation, and compassion.

Frum is 100% on target and the sooner sane Republicans get on board with what he suggests, the better. That may mean jettisoning the hate-filled Christofascists who rallied to Obamacare repeal, but that would be a very positive development for the GOP.

Life Expectancy is Increasing Except in the U.S.

America has the most expensive and least efficient healthcare system of any advanced nation.  On average Americans - at least those who can pay - pay two to three times more for heathcare notwithstanding Republican lies that the free market will lower costs.  History has shown, the opposite has been the case.  Now, even with Obamacare helping millions, the results are showing: life expectancy is increasing everywhere except in America.  The policies so extolled by the GOP simply aren't working.  The irony, of course, is that in many cases those most harmed by the GOP agenda voted Republican thanks to calls to racism and religious extremism.  A piece in the Washington Post looks at this sad picture.  Here are highlights:

 Here's a rare bit of good news: People are living longer than ever.

According to a new Lancet study, life expectancy will jump across much of the industrialized world in the next two decades. By 2030, women in South Korea can, ahem, expect to live to 90, up from 84 in 2010. Women in France, Japan and Spain on average will hit at least 88 or 89 years, up from around 85. Men in South Korea, Australia and Switzerland will also see big gains, living to about 84 by 2030. Fellows from Canada, Spain, New Zealand and the Netherlands will also make gains.

But one country is stuck treading water: the United States. According to experts who studied 35 countries, Americans will see only a small boost. In 2010, average life expectancy for men here was 76. By 2030, they can expect to live just three more years. For women, life expectancy will jump just two years, from 81 in 2010 to 83 in 2030.

Researchers said our low performance is notable because “life expectancy at birth is already lower than most other high-income countries, and is projected to fall further behind such that its 2030 life expectancy at birth might be similar to the Czech Republic for men, and Croatia and Mexico for women.” It's worth noting, too, that the researchers only looked at data until 2013 — so they missed the unprecedented decline in life expectancy that hit two years later.

Experts attribute the lag to economic inequality, particularly when it comes to health care. The United States is one of the only industrialized nations without universal health care. “This means that some groups are getting left behind, and it’s pulling the average down,” James Bennett, a researcher in the department of epidemiology and biostatistics at Imperial College London, told Vox. Americans also suffer higher rates of death from alcohol, drug use and mental disorders. We also have high rates of obesity, homicide and infant mortality, which drags down our average.

Other countries with high projected life expectancy include Australia, Canada and New Zealand. Researchers credit their high-quality health care, along with low smoking and traffic accidents. France and Switzerland did well because they had some of the lowest rates of obesity.

Yes, America is exceptional alright, but not in a good way!

California Democrats - Ready for Political War With Trump

I spoke by telephone last night with an older woman distraught over the recent election results who wanted to get more politically involved to oppose the Trumpist agenda.  Like many I suspect, she has had numerous run ins with friends and others who supported Trump and don't like to have it pointed out to them that they backed a racist and misogynist agenda, something that speaks volumes about them.  I gave her contact information for local Democrat circles and she pledged to get more involved.  The issue, of course, is who will lead the opposition to Trump and his make America white and heterosexual again agenda.  Here in Virginia, the immediate battle will be to make sure Democrats win all of the statewide offices in next year's elections.  On a more national front, perhaps California, where Democrats have vowed to fight the Trump agenda, can be a model for others. Bloomberg looks at the vows being made in California.  Here are excerpts:

The Republicans are about to control Congress and the presidency for the first time in a decade, and they have an ambitious agenda. They’ve promised to undo Obamacare, deport undocumented immigrants, and roll back environmental regulations. The Democrats who run the state government in California aren’t happy. Immediately after the election, state Senate President Kevin de León and his Assembly counterpart, Anthony Rendon, both Latinos from Southern California, sent out a scathing statement in English and Spanish assuring all 39 million Californians that they were ready for political war. “Today, we woke up feeling like strangers in a foreign land, because yesterday Americans expressed their views on a pluralistic and democratic society that are clearly inconsistent with the values of the people of California,” they wrote. “We will lead the resistance to any effort that would shred our social fabric or our Constitution.”

With the largest economy in the U.S. and the sixth-largest in the world, the state enjoys greater independence from Washington than most. It was the first state to adopt its own vehicle emissions standards, in 2002. In 2012, California created the only state-level cap-and-trade system for limiting greenhouse gas emissions after Republicans in Congress rejected a national model. California, which has more undocumented immigrants than any other state, offers them driver’s licenses as well as financial aid for college. It has imposed some of the country’s strictest background checks on firearms purchases. It’s one of three states to provide paid family and medical leave and one of five that require employers to offer paid sick leave. “This is unlike anything we’ve seen in modern political history,” says de León. “We’re going to do everything in our power to protect our people and our values as Californians.”

Hillary Clinton won more than 61 percent of the state’s vote, a higher share than President Obama won in 2012. Voters approved ballot measures decriminalizing recreational marijuana use, restricting ammunition purchases, and increasing taxes on the rich. The national election triggered a resurgence of California secession fantasies, this time under the hashtag #Calexit—a reference to Brexit, Britain’s vote to leave the European Union.

State Democrats say there’s plenty they can do short of leaving the U.S. California has long been a net contributor to Washington’s coffers . . . . That gives state leaders potential leverage when it comes to complying with policies it doesn’t like, starting with the deportation of undocumented immigrants.

On Nov. 14, Los Angeles Police Department Chief Charlie Beck said he won’t reverse long-standing department policy blocking officers from doing immigration enforcement, despite Donald Trump’s threats to cut federal funding to so-called sanctuary cities, which offer residents protection from federal agents. “We are not going to work with Homeland Security on deportation efforts,” Beck said. “That is not our job, nor will I make it our job.” 

One of the biggest points of contention between Sacramento and Trump’s Washington will be climate change. The incoming president has called global warming a hoax “created by and for the Chinese in order to make U.S. manufacturing noncompetitive.” . . . . Governor Brown has devoted himself to strengthening California’s carbon pollution rules, already the nation’s toughest. “We will protect the precious rights of our people and continue to confront the existential threat of our time—devastating climate change,” . . . . Oakland Mayor Libby Schaaf says cities should be willing to uphold the Paris commitments at the local level. 

California’s Democrats are also exploring ways to ensure continued access to health care. . . . A repeal [of Obamacare], as Trump and Republicans have pledged, would cost the state more than $15 billion in federal subsidies a year, according to the nonprofit Urban Institute. “In theory, California could implement its own universal health-care program,” says California’s insurance commissioner, Dave Jones—though doing so, he warns, would require significant state tax increases.

California leaders have taken steps to expand access to the procedure [abortion], and could make the state a haven for women seeking abortions if Roe were to fall. And some ideas that Trump has endorsed, like stop-and-frisk law enforcement policies, are determined at the local level, not by Congress.

Says Mayor Schaaf: “I think it is wise to not react too much to things that have not yet occurred, but rather to be prepared and strengthened in the event that they do.

Failed Right Wing Failed Policies and White Mortality Rates

I frequently post the cartoon image above to make the point that much of the Republican Party base is being played for fools (mostly by playing on their racism and bigotry) and convinced to vote against its own best interest.  But the problem goes far beyond foolishly supporting tax cuts for the rich and the slashing on regulations that protect citizens from vulture capitalism.  It goes to cheering the dismantling of social safety net programs and the right's refusal to put America's healthcare system on a par with that of other advanced industrial nations.  The irony, however, is in the fact that many angry white voters are rallying to support Republican candidates who, if allowed to do so, would make the plight of these individuals and their families even worse.  A column in the New York Times looks at the phenomenon and the way in which right wing policies are literally killing portions of the GOP base.  Here are highlights:

A couple of weeks ago President Obama mocked Republicans who are “down on America,”  . . . .  He had a point: With job growth at rates not seen since the 1990s, with the percentage of Americans covered by health insurance hitting record highs, the doom-and-gloom predictions of his political enemies look ever more at odds with reality.

There has been a lot of comment, and rightly so, over a new paper by the economists Angus Deaton (who just won a Nobel) and Anne Case, showing that mortality among middle-aged white Americans has been rising since 1999. This deterioration took place while death rates were falling steadily both in other countries and among other groups in our own nation.

Even more striking are the proximate causes of rising mortality. Basically, white Americans are, in increasing numbers, killing themselves, directly or indirectly. Suicide is way up, and so are deaths from drug poisoning and the chronic liver disease that excessive drinking can cause. We’ve seen this kind of thing in other times and places – for example, in the plunging life expectancy that afflicted Russia after the fall of Communism. But it’s a shock to see it, even in an attenuated form, in America.

 Yet the Deaton-Case findings fit into a well-established pattern. There have been a number of studies showing that life expectancy for less-educated whites is falling across much of the nation.

But what’s causing this epidemic of self-destructive behavior?   If you believe the usual suspects on the right, it’s all the fault of liberals.. . . . But (surprise!) this view is very much at odds with the evidence.

For one thing, rising mortality is a uniquely American phenomenon – yet America has both a much weaker welfare state and a much stronger role for traditional religion and values than any other advanced country. Sweden gives its poor far more aid than we do, and a majority of Swedish children are now born out of wedlock, yet Sweden’s middle-aged mortality rate is only half of white America’s.

Life expectancy is high and rising in the Northeast and California, where social benefits are highest and traditional values weakest. Meanwhile, low and stagnant or declining life expectancy is concentrated in the Bible Belt.


Most notably, Hispanic Americans are considerably poorer than whites, but have much lower mortality. It’s probably worth noting, in this context, that international comparisons consistently find that Latin Americans have higher subjective well-being than you would expect, given their incomes.

So what is going on? In a recent interview Mr. Deaton suggested that middle-aged whites have “lost the narrative of their lives.” That is, their economic setbacks have hit hard because they expected better. Or to put it a bit differently, we’re looking at people who were raised to believe in the American Dream, and are coping badly with its failure to come true.

I’m not the only observer who sees a link between the despair reflected in those mortality numbers and the volatility of right-wing politics. Some people who feel left behind by the American story turn self-destructive; others turn on the elites they feel have betrayed them. No, deporting immigrants and wearing baseball caps bearing slogans won’t solve their problems, but neither will cutting taxes on capital gains. So you can understand why some voters have rallied around politicians who at least seem to feel their pain.

But while universal health care, higher minimum wages, aid to education, and so on would do a lot to help Americans in trouble, I’m not sure whether they’re enough to cure existential despair.

Yes, the Great Recession was brutal to many.  But cutting off your nose to spite your face as angry whites rallying to the GOP doesn't solve the overarching problems.  Like the columnist, I believe that universal health care, a higher minimum wage, improved education , etc., are not the whole answer.  Other elements are needed such as ending the embrace of ignorance, ending adherence to Bronze Age religious beliefs, and walking away for GOP dog whistle racism are also needed.  The GOP and Koch brothers may malign "Old Europe" yet Europe's nations for the most part are affording their citizens a better life style without rising mortality rates. 

Today's GOP: Have Americans Gone Crazy?

GOP extremist, GOP Senator Joni Ernst

With the GOP suddenly speaking well of France and other member countries of the European Union, some in Europe must be wondering what has come over the erst while French hating Republicans.  But the bigger question in the minds of most foreigners, I suspect, especially from my own experience traveling outside the USA as far back as 2004 when my son and I were in Canada (every Canadian we met said we Americans deserved better than the Chimperator) and even as recently as this past September when the husband and I were in Venice and Greece, is how and why has America gone so insane and allowed the insane far right to be ascendant.  A piece in Salon looks  at the phenomenon.  Here are excerpts:

Americans who live abroad — more than six million of us worldwide (not counting those who work for the U.S. government) — often face hard questions about our country from people we live among. Europeans, Asians, and Africans ask us to explain everything that baffles them about the increasingly odd and troubling conduct of the United States.  Polite people, normally reluctant to risk offending a guest, complain that America’s trigger-happiness, cutthroat free-marketeering, and “exceptionality” have gone on for too long to be considered just an adolescent phase. Which means that we Americans abroad are regularly asked to account for the behavior of our rebranded “homeland,” now conspicuously in decline and increasingly out of step with the rest of the world.

I still remember a time when to be an American was to be envied. The country where I grew up after World War II seemed to be respected and admired around the world for way too many reasons to go into here.

That’s changed, of course. Even after the invasion of Iraq in 2003, I still met people — in the Middle East, no less — willing to withhold judgment on the U.S.  Many thought that the Supreme Court’s installation of George W. Bush as president was a blunder American voters would correct in the election of 2004. His return to office truly spelled the end of America as the world had known it.  Bush had started a war, opposed by the entire world, because he wanted to and he could. A majority of Americans supported him.  And that was when all the uncomfortable questions really began.

In the early fall of 2014, I traveled from my home in Oslo, Norway, through much of Eastern and Central Europe. Everywhere I went in those two months, moments after locals realized I was an American the questions started and, polite as they usually were, most of them had a single underlying theme: Have Americans gone over the edge? Are you crazy? Please explain.

Then recently, I traveled back to the “homeland.”  It struck me there that most Americans have no idea just how strange we now seem to much of the world. In my experience, foreign observers are far better informed about us than the average American is about them.   This is partly because the “news” in the American media is so parochial and so limited in its views both of how we act and how other countries think — even countries with which we were recently, are currently, or threaten soon to be at war.


Take the questions stumping Europeans in the Obama years (which 1.6 million Americans residing in Europe regularly find thrown our way).  At the absolute top of the list: “Why would anyone oppose national health care?” European and other industrialized countries have had some form of national health care since the 1930s or 1940s, Germany since 1880.  Some versions, as in France and Great Britain, have devolved into two-tier public and private systems.  Yet even the privileged who pay for a faster track would not begrudge their fellow citizens government-funded comprehensive health care. That so many Americans do strikes Europeans as baffling, if not frankly brutal.

Sweden led the way in the 1930s, and all five Nordic countries pitched in during the postwar period to develop their own variations of what came to be called the Nordic Model: a balance of regulated capitalism, universal social welfare, political democracy, and the highest levels of gender and economic equality on the planet. It’s their system. They invented it. They like it. Despite the efforts of an occasional conservative government to muck it up, they maintain it. Why?

In all the Nordic countries, there is broad general agreement across the political spectrum that only when people’s basic needs are met — when they can cease to worry about their jobs, their incomes, their housing, their transportation, their health care, their kids’ education, and their aging parents — only then can they be free to do as they like. While the U.S. settles for the fantasy that, from birth, every kid has an equal shot at the American dream, Nordic social welfare systems lay the foundations for a more authentic equality and individualism.

These ideas are not novel. They are implied in the preamble to our own Constitution.

Knowing that Americans used to support such ideas, a Norwegian today is appalled to learn that a CEO of a major American corporation makes between 300 and 400 times as much as its average employee. Or that governors Sam Brownback of Kansas and Chris Christie of New Jersey, having run up their state’s debts by cutting taxes for the rich, now plan to cover the loss with money snatched from the pension funds of workers in the public sector. 

Implications of brutality, or of a kind of uncivilized inhumanity, seem to lurk in so many other questions foreign observers ask about America like: How could you set up that concentration camp in Cuba, and why can’t you shut it down?  Or: How can you pretend to be a Christian country and still carry out the death penalty? The follow-up to which often is: How could you pick as president a man proud of executing his fellow citizens at the fastest rate recorded in Texas history?  (Europeans will not soon forget George W. Bush.)

Other things I’ve had to answer for include:
* Why can’t you Americans stop interfering with women’s health care?
* Why can’t you understand science?
* How can you still be so blind to the reality of climate change?
* How can you speak of the rule of law when your presidents break international laws to make war whenever they want?
* How can you hand over the power to blow up the planet to one lone, ordinary man?
* How can you throw away the Geneva Conventions and your principles to advocate torture?
* Why do you Americans like guns so much?  Why do you kill each other at such a rate?

To many, the most baffling and important question of all is: Why do you send your military all over the world to stir up more and more trouble for all of us?

That last question is particularly pressing because countries historically friendly to the United States, from Australia to Finland, are struggling to keep up with an influx of refugees from America’s wars and interventions.

Did you note the question about claims of being a "Christian nation"?  While America pretends much more religiosity than old Europe, when it comes to governmental policy, the European models are much more in line with the Gospel message than America's vulture capitalist inspired model that kicks the needy to the gutter.   And who drives the effort to destroy the social safety net in the USA?  The Christofascist base of the GOP, of course.   I find the words selfish hypocrites on my lips.

The GOP Has Lost the Obamacare Fight

As the prior post noted, rational and thinking Republicans realize that Obamacare and universal healthcare are here to stay and that the GOP war against the Affordable Health Care Act is lost.   Unfortunately, much of the GOP base, especially the lunatics of the Tea Party do not grasp that reality.  A column by Juan Williams in The Hill looks at why the war on Obamacare is lost.  Here are excerpts:

Republicans bet the house that ObamaCare would be a disaster. They lost.

After a four-year feast criticizing ObamaCare, Congressional Republicans are now left picking at the crumbs of minor complaints. Their longstanding predictions of failure have come up empty. The healthcare reform plan is successful.

Even if Republicans gain control of the Senate in the midterm elections, the best they can do is stage the first Senate vote to repeal ObamaCare. That will come after 50 or more similar votes by the GOP majority in the House.

President Obama will veto any repeal bill, so even holding a vote amounts to one last gesture of futility from the defeated army of right-wing opposition.

More sour grapes are on display in the House. Republicans once promised to pass a detailed House plan as an alternative to ObamaCare before the midterms. But with the president’s program successfully launched, the House leadership has decided not to commit to any Republican plan until after the election.

GOP leaders rightly fear any such announcement would lead to a backlash. Voters would likely see the possibility of conservative proposals bringing forth bigger disruptions in the insurance markets and less coverage for the uninsured.

This Republican reversal of fortune on healthcare is producing sounds of silence on the campaign trail. As the predicted wave of voter anger over healthcare reform has failed to appear, several GOP candidates are saying nothing or politely suggesting small fixes to the Affordable Care Act.

Just a few months ago, the chair of the National Republican Congressional Committee, Rep. Greg Walden of Oregon, forecast that ObamaCare would be the number one issue used by Republicans to thump Democrats in this cycle. It would be a “category 5 political hurricane,” he insisted.

It turns out it is the Republicans who are being storm-tossed. They are nervously scavenging for anything they can find to fire up their voters.  They are jumping on complaints about the IRS; second-guessing the deal to release a prisoner of war; and ramping up complaints about the president’s decision not to keep U.S. troops in turbulent Iraq.

But those efforts have not had success. A recent NBC/Wall Street Journal poll shows voters lean toward Democrats on the question of which party they want to win majority control of Congress in the midterm races. That result comes in the same poll that has the president matching his lowest job approval rating.

The problem for Republicans is stark: The steady performance of the Affordable Care Act is speaking louder than their scare tactics.

And there is more good news on the performance of healthcare reform. The Times reported last week that more pharmaceutical companies are cutting the price of drugs to comply with requirements of new healthcare plans. In addition, more insurance companies are joining exchange programs.

On top of all this, the growth rate of Medicare spending has slowed while the Congressional Budget Office now projects a lower price tag for the Affordable Care Act as a whole. That includes potential profits for taxpayers if the government does not have to use risk pools to compensate any losses by insurance companies. And at the moment that looks to be the case.

Will GOP "Reformicons" Become Extinct

As has been noted in some previous posts, there are some in the GOP - actually a very few - who believe that the GOP needs to reform its message and become a "party of ideas."  This agenda is at odds with much of the GOP base which embraces ignorance and instead wants to keep trying the same failed policies of the GOP from twenty or thirty years ago.  One could argue that these so-called "reformicons" are on a mission reminiscent of Don Quixote.   Their visions of reform run head long into the racism, greed, and religious extremism that are now the pillars of GOP policy.  A piece in the New York Times looks at this small effort to move the GOP into the 21st century.  Here are highlights:

Two young men, in particular, were responsible for this change: Yuval Levin, a former policy adviser to George W. Bush and founder of the earnest quarterly journal National Affairs, and Ramesh Ponnuru, a senior editor at National Review and columnist at Bloomberg View. Each is an intellectual prodigy in his 30s, and together they have become the leaders of a small band of reform conservatives, sometimes called reformicons, who believe the health of the G.O.P. hinges on jettisoning its age-old doctrine — orgiastic tax-cutting, the slashing of government programs, the championing of Wall Street — and using an altogether different vocabulary, backed by specific proposals, that will reconnect the party to middle-class and low-income voters.

The reformicons, it seemed, had captured their party’s imagination. But three weeks later, on June 10, the narrative of the newly in-touch G.O.P. met the colder reality of politics, with its pitiless winnowing of winners and losers. Eric Cantor, in what was supposed to be a cakewalk primary, succumbed to David Brat, a far-right challenger so obscure that national anti-establishment organizations like FreedomWorks and the Club for Growth, which poured millions into other insurgencies, kept out of this one.

[A] new story line emerged. Cantor became the losing face of reformism, the “poster boy” (as The Wall Street Journal called him) and “one of the patron saints” (Ezra Klein) of an “upscale faction of the party calling themselves ‘reform conservatives’ ” (Politico). The reformist wonks, crunching through numbers and looking for an alternative to the six-year strategy of “just say no,” were now depicted as the elite establishment of the G.O.P. And as Republican lawmakers and strategists look ahead to November and beyond, there was suddenly a new worry. Instead of saving the party from itself, the reformers risked being consumed by the Republicans’ ongoing identity crisis.

Democrats have pushed the policy debate, while Republicans have become a party of opposition. Today Republican “rule” often means obstruction, and its supposed principles sound like dogma. As for reality, it gave us the presidential prospects of Sarah Palin and Michele Bachmann and absurdist moments, like the Republican presidential-primary debate in which all eight participants said they would reject a hypothetical deal with Democrats in which one dollar of increased taxation would be exchanged for 10 dollars of reduced spending.

[T]his is not a hospitable moment for serious-minded intellectuals on the right. The place once claimed in the culture by Kristol and William F. Buckley Jr. is now inhabited by Fox News hosts and Rush Limbaugh and the radio host Laura Ingraham, who is widely credited with mobilizing the troops who expelled Eric Cantor from Congress. Levin is circumspect about the competing noise. 

[T]he appetite for ideological purity seemed insatiable and overrode all other considerations. Even cooler heads were persuaded that Mitt Romney would coast to victory as long as he could convince the activist wing of the party that he was a true conservative. “The result of the 2012 election was more disorienting than the ’08 election,” Ponnuru said. He described his futile attempt to educate House members at their annual retreat in January 2013, when Ponnuru worked through data showing that the loss couldn’t be pinned on Romney alone. “As much as people say Romney was a weak candidate, he ran ahead of Senate candidates in almost every state” — a crucial point that Ponnuru mentioned to the Republican caucus.

“The biggest problem is that the politicians don’t represent the people. We’re identified with the rich and big business,” she said, ticking off a list of constituencies that Republicans have alienated: “Single women, Hispanics, young people.” Also as a wife and mother, she had serious doubts about any movement “that can offer nothing to a married woman with three children at the bottom half” of the economic heap.

Levin and Ponnuru and other reformers also oppose same-sex marriage, but again choose not to make an issue of it, recognizing that the battle is lost — or soon will be, as indeed the culture war in general has been. That, in addition to the bleak facts of the weak economic recovery and irrefutable demographic trends, explains the reformers’ decision to channel their energies into economics and to become champions of middle-class America. 

Today many on the right, including the reformicons, insistently depict Obama as a radical, but they are well aware he kept all but the top sliver of George W. Bush’s giant tax cut. And for all the efforts to discredit Obamacare, it was ratified by the most conservative Supreme Court in modern history. Every reformer I talked to acknowledged that the principle of universal coverage is here to stay, in whatever form, including the operations advanced by Republicans who want to “repeal and replace” Obama’s plan, the basis of which was hatched from a conservative policy suggestion that originated in 1989 from the Heritage Foundation.

Why America Needs a Single Payer Heathcare Plan

Perhaps because of my former legal representation of a non-profit health care system with multiple hospitals, I find it difficult to trust the healthcare industry.  What I witnessed was a mindset focused on making money - lots of it - and monopoly like wars with other healthcare providers.  The delivery of quality, cost effective healthcare for all was nowhere on the radar screen.  And little has changed.  And far too little will change even with the advent of the Affordable Health Care Act, a/k/a Obamacare.  Why?  Because the basic plan keeps the existing flawed structure largely in place.  Yes, potentially many more Americans will have access to healthcare coverage.  But the same flawed and highly inefficient system that puts little value on patient care despite claims to the contrary will remain.  An op-ed in the New York Times acknowledges this reality and argues for a single payer system which would focus on the delivery of patient services rather than the enrichment of private sector corporations and individuals.  Here are excerpts:

TODAY marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful. 

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president’s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it. 

I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it. 

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.

For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke. . . .

And yet — I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month. 

Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care. 

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment. 

In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.) 

All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it.

Pope Francis Condemns Predatory Market Capitalism, Supports Universal Health Care

My verdict on Pope Francis remains out, especially until such time as he institutes a thorough house cleaning of the Roman Catholic Church hierarchy to sack all bishops and cardinals who participated in the conspiracy to protect sexual predator priests.  That said, Francis' latest lengthy announcement in a 224-page document, titled in Latin Evangelii Gaudium, cannot be good news for Republicans who claim to be loyal Catholics.  Francis makes it clear that unbridled capitalism and the kicking of the poor and unfortunate to the curb are NOT Catholic values.  Paul Ryan - who has already been condemned by the sleazy and morally bankrupt U.S. Conference of Catholic bishops for his attacks on the social safety net - in particular should be chastened by Francis' pronouncements - unless, of course his claims to being a god-fearing Catholic are just a pile of bullshit.  Francis' edict also calls for universal health care, something that is anathema to today's GOP and its Christofascist/Tea Party base.  Here are highlights from the National Catholic Reporter on Francis' edict:

Dreams can be powerful things, especially when articulated by leaders with the realistic capacity to translate them into action. That was the case 50 years ago with Martin Luther King Jr.'s famous "I Have a Dream" speech, and it also seems to be the ambition of Pope Francis' bold new apostolic exhortation, "The Joy of the Gospel."

In effect, the 224-page document, titled in Latin Evangelii Gaudium and released by the Vatican Tuesday, is a vision statement about the kind of community Francis wants Catholicism to be: more missionary, more merciful, and with the courage to change.

In particular, Francis calls for a church marked by a special passion for the poor and for peace.

The theme of change permeates the document. The pope says rather than being afraid of "going astray," what the church ought to fear instead is "remaining shut up within structures that give us a false sense of security, within rules that make us harsh judges" and "within habits that make us feel safe."

Francis acknowledges that realizing his dream will require "a reform of the church," stipulating that "what I am trying to express here has a programmatic significance and important consequences."

Though he doesn't lay out a comprehensive blueprint for reform, he goes beyond mere hints to fairly blunt indications of direction:

• He calls for a "conversion of the papacy," saying he wants to promote "a sound decentralization" and candidly admitting that in recent years "we have made little progress" on that front.
• He suggests that bishops' conferences ought to be given "a juridical status ... including genuine doctrinal authority." In effect, that would amount to a reversal of a 1998 Vatican ruling under John Paul II that only individual bishops in concert with the pope, and not episcopal conferences, have such authority.
• Francis criticizes forces within the church who seem to lust for "veritable witch hunts," asking rhetorically, "Whom are we going to evangelize if this is the way we act?"
• He cautions against "ostentatious preoccupation" for liturgy and doctrine as opposed to ensuring that the Gospel has "a real impact" on people and engages "the concrete needs of the present time."

The pope's toughest language comes in a section of the document arguing that solidarity with the poor and the promotion of peace are constituent elements of what it means to be a missionary church.

Francis denounces what he calls a "crude and naïve trust" in the free market, saying that left to its own devices, the market too often fosters a "throw-away culture" in which certain categories of people are seen as disposable. He rejects what he describes as an "invisible and almost virtual" economic "tyranny."

Specifically, Francis calls on the church to oppose spreading income inequality and unemployment, as well as to advocate for stronger environmental protection and against armed conflict.

Andrew Sullivan goes on to note as follows:

Here’s a representative passage:

Some people continue to defend trickle-down theories which assume that economic growth, encouraged by a free market, will inevitably succeed in bringing about greater justice and inclusiveness in the world. This opinion, which has never been confirmed by the facts, expresses a crude and naïve trust in the goodness of those wielding economic power and in the sacralized workings of the prevailing economic system. Meanwhile, the excluded are still waiting.

This is a Pope attacking Reaganomics! I’d also note that among the long-held tenets of Catholic social theory is universal healthcare. How to achieve universal healthcare is up for grabs among Catholics; but the moral need for universal healthcare isn’t.

Mr. Boehner and Mr. Ryan, are you listening??    Indeed, Francis' vision would seem to be the antithesis of the agenda of today's GOP both at the state and national levels.

A Message for Half-Wit Republicans Threatening to Emigrate to Australia

I've commented before on some of the cretins in the GOP who have threatened to leave America if Obama was reelected.  Most of the nations where they claim they'd go to - e.g., Canada, Costa Rica, Australia, etc. - have exactly the types of social policies the GOP says will ruin America.  Above is a reality check for those saying that they would go to Australia.  I guess Fox News doesn't provide much information on the real world.