Saturday, August 29, 2009

HHS: Insurance Companies Encourage Employees to "Revoke Sick People's Health Coverage"

Original Link:

By David S. Hilzenrath

You might have known that insurers can deny health coverage based on preexisting medical conditions, but here’s something else to worry about: They can take away the coverage you thought you had when actually need it, the government says.

The Department of Health and Human Services put a spotlight on that practice Tuesday in its continuing campaign to build support for an overhaul of health insurance.

“When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire,” the HHS said in a posting at HealthReform.Gov. In most states, insurance companies can retroactively cancel individuals' policies if any condition was not disclosed when the policy was obtained, "even if the medical condition is unrelated, and even if the person was not aware of the condition at the time.”

“Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition,” HHS said.

The department cited recent research by the staff of the House Committee on Energy and Commerce, which found that three large insurers rescinded almost 20,000 policies over five years, saving $300 million in medical claims.

At least one insurer included such savings in an employee performance evaluation.

“Simply put, these insurance company employees are encouraged to revoke sick people’s health coverage," HHS said

The research compiled recently for a House hearing included more detail.

WellPoint and Assurant told the committee that they automatically investigate the medical records of every policyholder with certain conditions, including leukemia, ovarian cancer, brain cancer, and becoming pregnant with twins, the committee staff wrote.

In November 2006, after a Texas resident was found to have a lump in her breast, Wellpoint investigated her medical history and concluded that she had been diagnosed previously with osteoporosis. The insurer rescinded her policy and refused to pay for treatment of the lump, the committee staff wrote.

Today’s HHS post, which draws on a variety of studies going back as far as 2001, shows how the Obama administration is trying to give people reasons to support an overhaul of health care even if they are satisfied with their existing coverage. It also reflects a stepped-up focus on health insurers, which are increasingly being cast as bogeymen in the debate.

Under the current system, something as relatively simple as seasonal sneezing can jeopardize your financial security, HHS argues, citing a 2001 study for the Kaiser Family Foundation.

“Even when offering coverage, insurers can exclude whole categories of illnesses related to a preexisting condition. For example, someone with a preexisting condition of hay fever could have any respiratory system disease – such as bronchitis or pneumonia – excluded from coverage,” HHS said.

Health care CEO: Can you spare some more stock options?

Original Link:

Poor little insurance company people... "We're people too", and we have feelings and we have families and jobs and feelings and so on and so forth.

Congratulations to the PR agencies and how they managed to humanize an industry that is based on profit and greed. Washington DC PR operatives deserve every dollar they get - turning an insurance clerk into the picture of an oppressed human being. Take advantage of their fear because they too might loose their jobs.

Now it's a crusade against workers in the insurance industry. Add another myth to the long list of tactics of the insurance industry.

Never mind that we ignore the salaries of the poor suffering CEOs.

Insurance Company & CEOs With 2007 Total CEO Compensation

Aetna Ronald A. Williams: $23,045,834
Cigna H. Edward Hanway: $25,839,777
Coventry Dale B. Wolf : $14,869,823
Health Net Jay M. Gellert: $3,686,230
Humana Michael McCallister: $10,312,557
U.Health Grp Stephen J. Hemsley: $13,164,529
WellPoint Angela Braly (2007): $9,094,271

Insurance Company & CEOs With 2008 Total CEO Compensation

Aetna, Ronald A. Williams: $24,300,112
Cigna, H. Edward Hanway: $12,236,740
Coventry, Dale Wolf: $9,047,469
Health Net, Jay Gellert: $4,425,355
Humana, Michael McCallister: $4,764,309
U. Health Group, Stephen J. Hemsley: $3,241,042
Wellpoint, Angela Braly: $9,844,212

Never mind that the stock options of health care CEOs who make their money on denying coverage is pathetically immoral. The current CEO of United Health, Steven Hemsley has $744,000,000.00 in stock options. That's over double the $333M Mega Millions Lotto prize tonight! Profits have increased 428% from 2000-2007 at United Health. Profits that come from denying benefits, canceling coverage and refusing to pay for "pre-existing conditions".

Congratulations to the Lewin Group that is owned by United Health Care for being a non-partisan think tank. Tell people lies. Spread fear and gossip --- Death panels, the end of Medicare, canceling veterans' care, Hitler-talk, race wars, mandatory abortions... Fear and doom! Let's call a spade a shovel.

The health care PR flacks want to make it a battle between the poor disheveled health care clerk versus the poor card carrying SEIU janitor. Victim against victim; the poor against the poor; the community of Lexington, Kentucky versus the Bronx in New York; the obese diabetic on Medicare and Social Security screaming against the needs of the uninsured single mother with breast cancer.

Did you see the video of a guy carrying a big sign that said, "KEEP YOUR GOVERNMENT HANDS OFF MY MEDICARE!!!" The flacks at Freedom Works have created astroturf that's better than a bot army! It's hugely appropriate that Freedom Works is led by a certain Dick Armey.

That is truly social engineering at it's finest!!! Use people's fear against themselves.

Look at the shiny objects! Poor people battling it out for the crumbs. How very sad!

The battle for insurance reform is a battle for the lives of people - real people with children, homes, friends and families.

"Hmmm... must create grassroots movement" --- let's get our lobbyist America's Health Insurance Plans to ask 50,000 insurance company employees to contact congressmen through letters, phone calls or visits to town hall meetings. Astroturf is definitely easier than grassroots movements.

California insurer Anthem Blue Cross sent an e-mail to its customers saying the legislation currently under consideration "does not meet our definition of responsible and sustainable reform" and "would likely have a significant negative impact on our partners and customers."

Anthem Blue Cross, a subsidiary of WellPoint, asks its customers to contact their congressional representatives "to get health care done - and done right." It also asks them to visit their Web site.

Anthem's e-mail says health care reform in its current state could cause tens of millions of Americans to lose their private coverage and end up in a government-run plan, limit customers' choices of the products they can purchase and how they can purchase health coverage, and could increase premiums.

Here's the rogue gallery of health care CEOs and how much they make.

Finally if you have time, take a look at Brave New Films new movie, "SICK FOR PROFIT".

It's not about the insurance company clerk's job. It's about providing the most basic human right - your health, our health, the country's health and future.

Thursday, August 27, 2009

GOP opposes plan, then seeks money

Original Link:


Georgia's Republican senators, Saxby Chambliss and Johnny Isakson, voted against the $787 billion economic stimulus package, blasting the bill as a bloated government giveaway.

Their disdain didn't stop them from later asking Defense Secretary Robert Gates to steer $50 million in stimulus money to a constituent's bio-energy project.

Gates didn't do it, but Chambliss, Isakson and other Republican opponents of the stimulus aren't going empty-handed.

Billions of dollars worth of Defense Department stimulus money is paying for repairs and construction at military installations in areas represented by lawmakers who said "no" to the legislation, according to an analysis by The Associated Press.

The request from Chambliss and Isakson isn't the only one Gates and other top defense officials received before and after President Barack Obama signed the stimulus law in February. Their pitch stands out, though, because of the GOP's staunch opposition.

As Congress considered the legislation earlier this year, Republicans called it a partisan bill bound to make the size of government grow, not the economy. Not a single House Republican voted in favor of the bill; only three Senate Republicans did so.

Trashing the stimulus and also welcoming the money is a sore point for Democrats who say the GOP can't have it both ways. But Republicans say there's no inconsistency in opposing wasteful spending while also backing worthwhile projects.

The Pentagon is staying out of the fight. Navy Cmdr. Darryn James, a Pentagon spokesman, said political considerations were not a factor as defense officials put together the department's stimulus spending plan. The two main criteria were that projects could be started quickly to boost the economy and would also improve the quality of life for military personnel.

In statements, Chambliss and Isakson said helping their constituents is an important part of their jobs. In this case, it was Bell BioEnergy of Tifton, Ga., which is developing a process to convert waste into fuel.

Overall, Georgia is getting just over $200 million in defense stimulus money for work at installations that include the Army's Fort Stewart and Fort Gordon, and Moody Air Force Base.

Just a few days after criticizing the "staggering" cost of the stimulus, Rep. Brett Guthrie, a Republican from Kentucky, urged Gates to consider using stimulus money to renovate a military hospital at Fort Knox, a sprawling Army base located in his congressional district.

The Pentagon's stimulus spending plan shows no money for the hospital repairs. But of the more than $159 million in military stimulus money slated for Kentucky, almost $38 million is for other repair work at Fort Knox. Most of the total, $110 million, goes to Fort Campbell, home to the Army's 101st Airborne Division. It's in Republican Ed Whitfield's district.

Oklahoma Republican Mary Fallin joined her Democratic colleague, Rep. Dan Boren, in asking Army Secretary Pete Geren to use $8.4 million in stimulus money for repairs to buildings at two Oklahoma National Guard sites.

Fallin had called the stimulus a "Big Brother spending program" that didn't do enough to finance needed infrastructure projects. The money she and Boren sought isn't in the Pentagon's spending plans.

The Pentagon was allotted $7.4 billion in stimulus money, the bulk of it for overdue base repairs and new construction. About $5 billion is going to 16 states that top the Pentagon's stimulus spending list, including California, Texas, Florida, Virginia, Georgia and Kentucky, where the military has a significant presence.

About $1.2 billion is for new hospitals at Fort Hood, an Army base in Texas Republican John Carter's district, and Camp Pendleton, a Marine Corps base in California Republican Darrell Issa's district. The two hospitals are the largest individual projects to be paid for with defense stimulus dollars.

Carter voted against the bill, saying the stimulus would pile debt on future generations. But he hailed the $621 million hospital project as a victory for the economy in central Texas, where Fort Hood occupies more than 217,000 acres.

Construction of the Fort Hood hospital is scheduled to begin in September 2010. Also planned for the base is $100 million more in stimulus money for work ranging from road repairs to replacing heating and cooling systems.

John Stone, Carter's spokesman, said the congressman has been pushing for several years to get a new hospital at Fort Hood. The new hospital is also supported by Rep. Chet Edwards, a Texas Democrat who chairs the House subcommittee that controls military construction spending. Carter is also on the subcommittee.

The Democratic Congressional Campaign Committee is logging Republican names into a "Hypocrisy Hall of Fame," an online catalog of GOP lawmakers who voted against the stimulus package yet are "celebrating the benefits of President Obama's economic recovery bill in their districts."

One of the most recent names added to the Democratic list is Rep. Bill Young of Florida, whose congressional Web site contains a page with dozens of links to help Floridians "take advantage of federal stimulus money." Another is Rep. Eric Cantor of Virginia, a top House Republican who supports a high-speed rail project that's included in the bill.

Brad Dayspring, Cantor's spokesman, said the congressman has long backed the commercial rail project, which would connect Washington and Richmond, Va.

Tuesday, August 25, 2009

This Isn’t Reform, It’s Robbery

Original Link:

By Chris Hedges

Percentage change since 2002 in average premiums paid to large US health-insurance companies: +87%

Percentage change in the profits of the top ten insurance companies: +428%

Chances that an American bankrupted by medical bills has health insurance: 7 in 10

—Harper’s Index, September 2009

Capitalists, as my friend Father Michael Doyle says, should never be allowed near a health care system. They hold sick children hostage as they force parents to bankrupt themselves in the desperate scramble to pay for medical care. The sick do not have a choice. Medical care is not a consumable good. We can choose to buy a used car or a new car, shop at a boutique or a thrift store, but there is no choice between illness and health. And any debate about health care must acknowledge that the for-profit health care industry is the problem and must be destroyed. This is an industry that hires doctors and analysts to deny care to patients in order to increase profits. It is an industry that causes half of all bankruptcies. And the 20,000 Americans who died last year because they did not receive adequate care condemn these corporations as complicit in murder.

The current health care debate in Congress has nothing to do with death panels or public options or socialized medicine. The real debate, the only one that counts, is how much money our blood-sucking insurance, pharmaceutical and for-profit health services are going to be able to siphon off from new health care legislation. The proposed plans rattling around Congress all ensure that the profits for these corporations will increase and the misery for ordinary Americans will be compounded. The corporate state, enabled by both Democrats and Republicans, is yet again cannibalizing the Treasury. It is yet again pushing Americans, especially the poor and the working class, into levels of despair and rage that will continue to fuel the violent, proto-fascist movements leaping up around the edges of American society. And the traditional watchdogs—those in public office, the press and citizens groups—are as useless as the perfumed fops of another era who busied their days with court intrigue at Versailles. Canada never looked so good.

The Democrats are collaborating with lobbyists for the insurance industry, the pharmaceutical industry and for-profit health care providers to craft the current health care reform legislation. “Corporate and industry players are inside the tent this time,” says David Merritt, project director at Newt Gingrich’s Center for Health Transformation, “so there is a vacuum on the outside.” And these lobbyists have already killed a viable public option and made sure nothing in the bills will impede their growing profits and capacity for abuse.

“It will basically be a government law that says you have to buy their defective product,” says Dr. David Himmelstein, a professor at Harvard Medical School and a founder of Physicians for a National Health Plan. “Next the government will tell us a Pinto in every garage, a lead-coated toy to every child and melamine-laced puppy chow for every dog.”

“Health insurance is not a race to the top; it is a race to the bottom,” he told me from Cambridge, Mass. “The way you make money is by abusing people. And if a public-option plan is not ready and willing to abuse patients it is stuck with the expensive patients. The premiums will go up until it is noncompetitive. The conditions that have now been set for the plans include a hobbled public option. Under the best-case scenario there will be tens of millions [who] will remain uninsured at the outset, and the number will climb as more and more people are priced out of the insurance market.”

The inclusion of these corporations in the crafting of health care legislation has not stopped figures like Rick Scott, the former head of the Columbia/HCA health care company, from attempting to sabotage any plan. Scott’s company was forced to pay a $1.7 billion fraud settlement—the largest health care fraud settlement in U.S. history—for stealing hundreds of millions from taxpayers by overbilling for medical care. Scott, who made his money primarily from Medicare, is now saturating the airwaves in a reputed $20 million ad campaign that is stoking the anger and fear of many Americans. His ads are coordinated by CRC Public Relations, the group that masterminded the “Swift boat” attacks against 2004 Democratic presidential candidate John Kerry.

“They are using our money to campaign against us,” Dr. Himmelstein told me. “The money for these commercials came from health care interests that collect fees from American patients. We experienced this before in Massachusetts. We ran a ballot initiative for universal health care in 2000 and the insurance industry spent $5 million on it, including the insurance company I am insured by. They used my premiums to smear an idea that 70 percent in Massachusetts, according to polls, favored before this smear campaign. Universal health care was narrowly defeated.”

The bills now in Congress will, at best, impose on the country the failed model in Massachusetts. That model will demand that Americans buy health insurance from private insurers. There will be some subsidies for the very poor but not for anyone above a modest income. Insurers will be allowed to continue to jack up premiums, including for the elderly. The bankruptcies due to medical bills and swelling premiums will mount along with rising deductibles and co-payments. Health care will be beyond the reach of many families. In Massachusetts one in six people who have mandated insurance still say they cannot afford care, and 30,000 people were evicted from the state program this month because of budget cuts. Expect the same debacle nationwide.

“For someone my age who is making $40,000 a year you are required to lay out $5,000 for an insurance premium for coverage that covers nothing until you have spent $2,000 out of pocket,” Himmelstein said. “You are $7,000 out of pocket before you have any coverage at all. For most people that means you are already bankrupt before you have insurance. If anything, that has made them worse off. Instead of having that $5,000 to cover some of their medical expenses they have laid it out in premiums.”

The U.S. spends twice as much as other industrialized nations on health care—$7,129 per capita—although 45.7 million Americans remain without health coverage and millions more are inadequately covered. There are 14,000 Americans a day now losing their health coverage. A report in the journal Health Affairs estimates that, if the system is left unchanged, one of every five dollars spent by Americans in 2017 will go to health coverage. Private insurance bureaucracy and paperwork consume one-third, 31 percent, of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough, Physicians for a National Health Plan points out, to provide comprehensive, high-quality coverage for all Americans. But the proposed America’s Affordable Health Choices Act of 2009 (H.R. 3200 in the House) will, rather than cut costs, add an estimated $239 billion over 10 years to the federal deficit. This is very good for the corporations. It is very bad for us.

The lobbyists have, as they did with the obscene bailouts for banks and investment firms, hijacked legislation in order to fleece the citizen. The five largest private health insurers and their trade group, America’s Health Insurance Plans, spent more than $6 million on lobbying in the first quarter of 2009. Pfizer, the world’s biggest drug maker, spent more than $9 million during the last quarter of 2008 and the first three months of this year. The Washington Post reported that up to 30 members of Congress from both parties who hold key committee memberships have major investments in health care companies totaling between $11 million and $27 million. President Barack Obama’s director of health care policy, who will not discuss single-payer as an option, has served on the boards of several health care corporations.

Obama and the congressional leadership have shut out advocates of single-payer. The press, including papers such as The New York Times, treats single-payer as a fringe movement. The television networks rarely mention it. And yet between 45 and 60 percent of doctors favor single-payer. Between 40 and 62 percent of the American people, including 80 percent of registered Democrats, want universal, single-payer not-for-profit health care for all Americans. The ability of the corporations to discredit and silence voices that represent at least half of the population is another sad testament to the power of our corporate state.

“We are considering a variety of striking efforts for early in the fall,” Dr. Himmelstein said, “including protests outside state capitals by doctors around the country, video links of conferences in 70 or 80 cities around the country, with protests and potential doctors chaining themselves to the fence of the White House.”

Make sure you join them.

5 Myths About Health Care Around the World

Original Link:

By T.R. Reid

As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.

I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans.

In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet's purest examples of government-run health care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you don't get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don't bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" I asked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject applicants with a "preexisting condition" -- precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.

Monday, August 24, 2009

Dying for affordable healthcare — the uninsured speak

Original Link:

By Ed Pilkington

In the furious debate gripping America over the future of its health system, one voice has been lost amid the shouting. It is that of a distinguished gynaecologist, aged 67, called Dr Joseph Manley.

For 35 years Manley had a thriving health clinic in Kansas. He lived in the most affluent neighbourhood of Kansas City and treated himself to a new Porsche every year. But this is not a story about doctors' remuneration and their lavish lifestyles.

In the late 1980s he began to have trouble with his own health. He had involuntary muscle movements and difficulty swallowing. Fellow doctors failed to diagnose him, some guessing wrongly that he had post-traumatic stress from having served in the airforce in Vietnam.

Eventually his lack of motor control interfered with his work to the degree that he was forced to give up his practice. He fell instantly into a catch 22 that he had earlier seen entrap many of his own patients: no work, no health insurance, no treatment.
He remained uninsured and largely untreated for his progressively severe condition for the following 11 years. Blood tests that could have diagnosed him correctly were not done because he couldn't afford the $200. Having lost his practice, he lost his mansion on the hill and now lives in a one-bedroom apartment in the suburbs. His Porsches have made way for bangers. Many times this erstwhile pillar of the medical establishment had to go without food in order to pay for basic medicines. In 2000 Manley finally found the help he needed, at a clinic in Kansas City that acts as a rare safety net for uninsured people. He was swiftly diagnosed with Huntington's disease, a degenerative genetic illness, and now receives regular medical attention through the clinic.

So how does he feel about the way the debate in the US has come to be dominated by Republican-inspired attacks on Britain's NHS and other "socialised" health services which give people the treatment they need even if they cannot afford to pay for it?

"I find that repulsive and an absolutely bone-headed way to go," he says. "When I started out practising I certainly didn't expect this would happen. I thought the system would take care of everybody."

Over the last month President Obama's attempts to live up to his election promise to extend healthcare to all Americans has stalled in the face of a sustained rightwing guerrilla attack. Opponents of Obama's reforms have succeeded in distracting attention from Manley and the 46 million other medically uninsured, swinging the focus instead on to the "evils" of publicly funded healthcare. The fear tactics were epitomised by Sarah Palin's wholly inaccurate claim that the reforms would set up "death panels" that would force euthanasia on to older people.

Such scaremongering has dismayed and infuriated Sharon Lee, the doctor who now treats Manley in Kansas City. "I'm very angry, very angry," she says. "Many of the people I treat have already been in front of a death panel and have lost – a death panel controlled by insurance companies. I see people dying at least monthly because we have been unable to get them what they needed."

Lee's clinic, Family Health Care, is a refuge of last resort. It picks up the pieces of lives left shattered by a health system that has failed them, and tries to glue them back together. It exists largely outside the parameters of formal health provision, raising funds through donations and paying all its 50 staff – Lee included – a flat rate of just $12 an hour.

Poverty line

Lee has just opened an outpost of her clinic in the outlying neighbourhood of Quindaro, an area of boarded-up houses and deserted factories where work is hard to find and crack plentiful and a per capita income is $11,025. A third of the population is below the federally defined poverty line.

And yet the local health department has decided the only health centre in the area will be closed by the end of this year and moved 30 blocks west to a much more prosperous part of the city where income levels are five times higher. Before long, one of the poorest areas of Kansas – of America – will be left without a single doctor, with only Lee's voluntary services to fall back on.

Even that is academic. Many of the residents of Quindaro were unable to see a doctor in any case – because they were uninsured. In Kansas, anyone who is able-bodied but unemployed is not eligible for government-backed health insurance as is anyone earning more than 39% of federal poverty levels. That leaves a huge army of jobless and low-income working families who are left in limbo. "It's the working poor who are most at disadvantage," Lee says.

As a result, she sees the same pattern repeating itself over and over. People with no insurance avoid seeking medical help for fear of the bills that follow, until it is too late. "When people come in they are already very, very sick. They have avoided seeing the doctor thinking that something may clear up, hoping they may be getting better."

Beth Gabaree, who came in to see Lee for the first time this morning, has experiences that sound extreme but are in fact quite typical. She has diabetes and a heart condition. Until two years ago they were controlled through ongoing treatment paid for by her husband's work-based health insurance. But he was in a motorbike crash that pulverised his right leg and put him out of work.

That Catch 22 again: no work, no insurance, no treatment. Except in this case it was Beth who went without treatment, in order to put her husband's dire needs first. He receives ongoing specialist care that costs them $500 a go, leaving nothing for her. So she stopped seeing a doctor, and effectively began self-medicating. She cut down from two different insulin drugs to regulate her diabetes to one, and restricted her heart drugs. "I do what I think I need to do to keep four steps out of hospital. I know that's not the right thing, but I can't justify seeing the doctor when my family's already in money trouble."

The problem is that she hasn't kept herself four steps out of hospital. Her health deteriorated and earlier this year she became bedridden. Even then, it took her family several days to persuade her to go to the emergency room because she didn't want to incur the hospital costs. "It was hard enough without that," she says.

After an initial consultation, Lee has now booked Gabaree for a new round of tests for her diabetes and is arranging for free medication. "It's wonderful," Gabaree says. "I'm so blessed. I didn't know you could get this sort of help."

That she sees basic healthcare as a blessing, not as a right, speaks volumes about attitudes among the mass of the working poor. Also revealing is the fact that Gabaree has absolutely no idea about the debate raging across America. She hasn't even heard of Obama's push for health reform, nor the Republican efforts to prevent it. "I don't watch much television," she says.

That provides Palin et al with a massive advantage: the 46 million people who would most benefit from Obama's plans are also among the least educated and informed, and thus the least able to make political waves. All of which leaves Lee fearful about the prospects for change. She has, after all, been here before – in 1993 when Hillary Clinton's pitch to overhaul the health system foundered. That attempt ended up doing more harm than good from Lee's perspective. Many of her most important donors stopped funding the centre because they assumed that the White House was fixing the problems. After the Clinton reforms crashed, brought down by the same rightwing assault that Obama is now enduring, it took many months for the centre's funds to regain their pre-1993 levels.


Lee fears history could be repeating itself. This time round there is the recession more unemployed equals more uninsured people who come knocking on the door of Family Health Care. Last year Lee and one other doctor between them dealt with 14,000 visits, and the numbers are rising daily. All of which leaves Lee part despairing, part determined to fight even harder for the bare minimum of human dignity. The frustration is that every day she must beg and plead with other health providers for simple treatments for her patients. "It drives me crazy with frustration," she says.

She rattles off a litany of horror stories. There was the man who walked into the clinic with a brain tumour. It took Lee three months to get him an MRI scan and another two to get an appointment with a neurosurgeon. Or the patient whose nerves in his neck were pushed against his spinal cord so that he lost use of both arms; by the time Lee found a way of getting him an MRI he was so sick he had to be operated on immediately. Or the woman who had such heavy periods she would wind up in ER every three months requiring a blood transfusion. What she really needed was a hysterectomy. "It took us almost a year to beg hospitals until she finally did get a hysterectomy," Lee says.

These are the stories, the broken lives, that have been obscured by the fury generated by the Republican rump. Unless Obama finds a way to regain the political initiative, to remind Americans that only nine months ago they voted overwhelmingly for change, then the future of millions appears bleak.

"Here's what I'd like to ask Palin," Lee says. "People without health insurance are dying, here in America, right now. So I'd like to ask her: how does that fit into your vision of good and evil, Sarah Palin?"

What is Obama trying to do?

The goal is to increase access to healthcare by regulating costs. His plan would guarantee all citizens eligibility for care, but the government is not proposing a "single-payer system", like the NHS. Instead, private health insurers would continue to operate under new rules that would lower premiums and remove loopholes that allow them to avoid paying for treatment when it is most needed. Per person, healthcare costs are higher in the US than in any other country, and have been rising faster than the level of inflation. The quality of care is less of an issue — although citizens with solid insurance may be frustrated by the paperwork and costs associated with the current system, they have fewer complaints about their doctors and hospitals.

Who's opposing Obama's plan?

Those who fear the government would introduce congressional "death panels" to make end-of-life decisions for the elderly. The insurance industry is worried about their bottom lines. Members of Congress and voters on the left and right are concerned about the future tax burden. Many Americans also object to any increase in government involvement in their personal lives.

How can healthcare costs get so out of hand?

Many insurance plans do not cover "pre-existing conditions", so it can be difficult for people who have a chronic ailment to secure cover. Loopholes allow insurers to refuse reimbursement even if the policyholder did not know they had a particular condition when they took out insurance. "Lifetime caps" allow insurers to set a maximum amount of cover.

Who are the uninsured?

Up to 46 million Americans are uninsured, because they are unemployed, or their employer does not provide cover, or because they do not qualify for existing government-funded healthcare. People 65 and older can qualify for Medicare, the poor can qualify for Medicaid, veterans and members of the military can qualify for Veterans Health Administration and Tricare and children can be covered under a programme called SCHIP. Those overlooked by the system include the young just entering the workforce, the self-employed, the unemployed and people who work for small businesses.

Sunday, August 23, 2009

Republicans, religion and the triumph of unreason

Original Link:

By Johann Hari

How do they train themselves to be so impervious to reality?

Something strange has happened in America in the nine months since Barack Obama was elected. It has best been summarised by the comedian Bill Maher: "The Democrats have moved to the right, and the Republicans have moved to a mental hospital."

The election of Obama – a black man with an anti-conservative message – as a successor to George W. Bush has scrambled the core American right's view of their country. In their gut, they saw the US as a white-skinned, right-wing nation forever shaped like Sarah Palin.

When this image was repudiated by a majority of Americans in a massive landslide, it simply didn't compute. How could this have happened? How could the cry of "Drill, baby, drill" have been beaten by a supposedly big government black guy? So a streak that has always been there in the American right's world-view – to deny reality, and argue against a demonic phantasm of their own creation – has swollen. Now it is all they can see.

Since Obama's rise, the US right has been skipping frantically from one fantasy to another, like a person in the throes of a mental breakdown. It started when they claimed he was a secret Muslim, and – at the same time – that he was a member of a black nationalist church that hated white people. Then, once these arguments were rejected and Obama won, they began to argue that he was born in Kenya and secretly smuggled into the United States as a baby, and the Hawaiian authorities conspired to fake his US birth certificate. So he is ineligible to rule and the office of President should pass to... the Republican runner-up, John McCain.

These aren't fringe phenomena: a Research 200 poll found that a majority of Republicans and Southerners say Obama wasn't born in the US, or aren't sure. A steady steam of Republican congressmen have been jabbering that Obama has "questions to answer". No amount of hard evidence – here's his birth certificate, here's a picture of his mother heavily pregnant in Hawaii, here's the announcement of his birth in the local Hawaiian paper – can pierce this conviction.

This trend has reached its apotheosis this summer with the Republican Party now claiming en masse that Obama wants to set up "death panels" to euthanise the old and disabled. Yes: Sarah Palin really has claimed – with a straight face – that Barack Obama wants to kill her baby.

You have to admire the audacity of the right. Here's what's actually happening. The US is the only major industrialised country that does not provide regular healthcare to all its citizens. Instead, they are required to provide for themselves – and 50 million people can't afford the insurance. As a result, 18,000 US citizens die every year needlessly, because they can't access the care they require. That's equivalent to six 9/11s, every year, year on year. Yet the Republicans have accused the Democrats who are trying to stop all this death by extending healthcare of being "killers" – and they have successfully managed to put them on the defensive.

The Republicans want to defend the existing system, not least because they are given massive sums of money by the private medical firms who benefit from the deadly status quo. But they can't do so honestly: some 70 per cent of Americans say it is "immoral" to retain a medical system that doesn't cover all citizens. So they have to invent lies to make any life-saving extension of healthcare sound depraved.

A few months ago, a recent board member for several private health corporations called Betsy McCaughey reportedly noticed a clause in the proposed healthcare legislation that would pay for old people to see a doctor and write a living will. They could stipulate when (if at all) they would like care to be withdrawn. It's totally voluntary. Many people want it: I know I wouldn't want to be kept alive for a few extra months if I was only going to be in agony and unable to speak. But McCaughey started the rumour that this was a form of euthanasia, where old people would be forced to agree to death. This was then stretched to include the disabled, like Palin's youngest child, who she claimed would have to "justify" his existence. It was flatly untrue – but the right had their talking-point, Palin declared the non-existent proposals "downright evil", and they were off.

It's been amazingly successful. Now, every conversation about healthcare has to begin with a Democrat explaining at great length that, no, they are not in favour of killing the elderly – while Republicans get away with defending a status quo that kills 18,000 people a year. The hypocrisy was startling: when Sarah Palin was Governor of Alaska, she encouraged citizens there to take out living wills. Almost all the Republicans leading the charge against "death panels" have voted for living wills in the past. But the lie has done its work: a confetti of distractions has been thrown up, and support is leaking away from the plan that would save lives.

These increasingly frenzied claims have become so detached from reality that they often seem like black comedy. The right-wing magazine US Investors' Daily claimed that if Stephen Hawking had been British, he would have been allowed to die at birth by its "socialist" healthcare system. Hawking responded with a polite cough that he is British, and "I wouldn't be here without the NHS".

This tendency to simply deny inconvenient facts and invent a fantasy world isn't new; it's only becoming more heightened. It ran through the Bush years like a dash of bourbon in water. When it became clear that Saddam Hussein had no weapons of mass destruction, the US right simply claimed they had been shipped to Syria. When the scientific evidence for man-made global warming became unanswerable, they claimed – as one Republican congressman put it – that it was "the greatest hoax in human history", and that all the world's climatologists were "liars". The American media then presents itself as an umpire between "the rival sides", as if they both had evidence behind them.

It's a shame, because there are some areas in which a conservative philosophy – reminding us of the limits of grand human schemes, and advising caution – could be a useful corrective. But that's not what these so-called "conservatives" are providing: instead, they are pumping up a hysterical fantasy that serves as a thin skin covering some raw economic interests and base prejudices.

For many of the people at the top of the party, this is merely cynical manipulation. One of Bush's former advisers, David Kuo, has said the President and Karl Rove would mock evangelicals as "nuts" as soon as they left the Oval Office. But the ordinary Republican base believe this stuff. They are being tricked into opposing their own interests through false fears and invented demons. Last week, one of the Republicans sent to disrupt a healthcare town hall started a fight and was injured – and then complained he had no health insurance. I didn't laugh; I wanted to weep.

How do they train themselves to be so impervious to reality? It begins, I suspect, with religion. They are taught from a young age that it is good to have "faith" – which is, by definition, a belief without any evidence to back it up. You don't have "faith" that Australia exists, or that fire burns: you have evidence. You only need "faith" to believe the untrue or unprovable. Indeed, they are taught that faith is the highest aspiration and most noble cause. Is it any surprise this then percolates into their political views? Faith-based thinking spreads and contaminates the rational.

Up to now, Obama has not responded well to this onslaught of unreason. He has had a two-pronged strategy: conciliate the elite economic interests, and joke about the fanatical fringe they are stirring up. He has (shamefully) assured the pharmaceutical companies that an expanded healthcare system will not use the power of government as a purchaser to bargain down drug prices, while wryly saying in public that he "doesn't want to kill Grandma". Rather than challenging these hard interests and bizarre fantasies aggressively, he has tried to flatter and soothe them.

This kind of mania can't be co-opted: it can only be overruled. Sometimes in politics you will have enemies, and they must be democratically defeated. The political system cannot be gummed up by a need to reach out to the maddest people or the greediest constituencies. There is no way to expand healthcare without angering Big Pharma and the Republicaloons. So be it. As Arianna Huffington put it, "It is as though, at the height of the civil rights movement, you thought you had to bring together Martin Luther King and George Wallace and make them agree. It's not how change happens."

However strange it seems, the Republican Party really is spinning off into a bizarre cult who believe Barack Obama is a baby-killer plotting to build death panels for the grannies of America. Their new slogan could be – shrill, baby, shrill.

Competition lacking among private health insurers

Original Link:


One of the most widely accepted arguments against a government medical plan for the middle class is that it would quash competition — just what private insurers seem to be doing themselves in many parts of the U.S.

Several studies show that in lots of places, one or two companies dominate the market. Critics say monopolistic conditions drive up premiums paid by employers and individuals.

For Democrats, the answer is a public plan that would compete with private insurers. Republicans see that as a government power grab. President Barack Obama looks to be trapped in the middle of an argument that could sink his effort to overhaul the health care system.

Even lawmakers opposed to a government plan have problems with the growing clout of the big private companies.

"There is a serious problem with the lack of competition among insurers," said Republican Sen. Olympia Snowe of Maine, one of the highest-cost states. "The impact on the consumer is significant."

Wellpoint Inc. accounted for 71 percent of the Maine market, while runner-up Aetna had a 12 percent share, according to a 2008 report by the American Medical Association.

Proponents of a government plan say it could restore a competitive balance and lead to lower costs. For one thing, it wouldn't have to turn a profit.

A study by the Urban Institute public policy center estimated that a public plan could save taxpayers from $224 billion to $400 billion over 10 years by lowering the cost of proposed subsidies for the uninsured, while preserving private coverage for most people.

"Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."

"The private plans would come back to the providers and say, 'If you don't negotiate with me, you're going to be left with only the public plan.'" Blumberg continued. "Suddenly, you have a very strong economic incentive for them to negotiate."

Insurers contend their industry is extremely competitive, and a public plan is unnecessary. About 1,300 carriers operate across the country, although many only have a small share of the market in their states.

"You can have a very competitive market and still have companies with a high market share," said Alissa Fox, a top Washington lobbyist for the Blue Cross Blue Shield Association.

Fox points to the federal employee health program, which also covers members of Congress. It offers a total of more than 260 options and 10 nationwide plans. Despite all the choices, about 60 percent of federal workers pick a Blue Cross plan.

"Insurers need to be of a significant size to best serve their customers and make sure that people get the best value," Fox said.

Nonetheless, lawmakers are concerned. Big insurers are getting bigger. Small businesses in particular have fewer and fewer options for getting coverage.

Congressional investigators this year looked at insurers catering to small employers around the country. The Government Accountability Office found that the median _or midpoint — market share of the largest carrier increased to 47 percent in 2008 from 33 percent in 2002.

There's widespread recognition among lawmakers that a health care overhaul should foster more competition among insurers. The debate is over how far to go.

The basic framework lawmakers are looking at would encourage competition, even without a government plan. It calls for setting up a big insurance purchasing pool called an exchange. It would be open, at least initially, to individuals and small businesses. The government would offer subsidies to make premiums more affordable.

Consumers would find it much easier to shop for a plan through the exchange. For one thing, they would be able to readily compare benefits and premiums in different plans. Also, participating insurers would have to take all applicants and not charge higher premiums to those in poor health.

Offering the option of a public plan would supercharge the competition, supporters say.

Blumberg envisions a plan that pays medical providers more than Medicare, but less than private insurance. Her study estimated it could grow to 47 million members, leaving 161 million with private insurance. Even so, that would make the new public plan one of the largest insurers in the country, rivaling Medicare, Medicaid and big private companies such as Wellpoint and UnitedHealthcare.

It's a scenario that gives pause even to traditional adversaries of the insurance companies.

"The fear and concern is that the public plan could become the market-dominant plan," said Dr. James Rohack, president of the American Medical Association. "When you've got the federal government involved, it can infuse money into a plan to keep it solvent even if the premiums are lower than its actual costs."

Snowe, among the few Republican senators still trying to come up with a bipartisan compromise, wants to hold back on creating a public plan for now and give insurers one last chance to show if they can keep costs in check.

That's doesn't go far enough for liberals, who are loath to give the insurance industry tens of millions of new customers supported by taxpayer subsidies.

"It would give the industry a windfall without any countervailing force to require them to lower their costs," said Richard Kirsch, national campaign manager for the advocacy group Health Care for America Now. "The insurance companies could continue to jack up premiums while getting a whole new market."

Saturday, August 22, 2009

The brutal truth about America’s healthcare

Original Link:

By Guy Adams

They came in their thousands, queuing through the night to secure one of the coveted wristbands offering entry into a strange parallel universe where medical care is a free and basic right and not an expensive luxury. Some of these Americans had walked miles simply to have their blood pressure checked, some had slept in their cars in the hope of getting an eye-test or a mammogram, others had brought their children for immunisations that could end up saving their life.

In the week that Britain's National Health Service was held aloft by Republicans as an "evil and Orwellian" example of everything that is wrong with free healthcare, these extraordinary scenes in Inglewood, California yesterday provided a sobering reminder of exactly why President Barack Obama is trying to reform the US system.

The LA Forum, the arena that once hosted sell-out Madonna concerts, has been transformed – for eight days only – into a vast field hospital. In America, the offer of free healthcare is so rare, that news of the magical medical kingdom spread rapidly and long lines of prospective patients snaked around the venue for the chance of getting everyday treatments that many British people take for granted.

In the first two days, more than 1,500 men, women and children received free treatments worth $503,000 (£304,000). Thirty dentists pulled 471 teeth; 320 people were given standard issue spectacles; 80 had mammograms; dozens more had acupuncture, or saw kidney specialists. By the time the makeshift medical centre leaves town on Tuesday, staff expect to have dispensed $2m worth of treatments to 10,000 patients.

The gritty district of Inglewood lies just a few miles from the palm-lined streets of Beverly Hills and the bright lights of Hollywood, but is a world away. And the residents who had flocked for the free medical care, courtesy of mobile charity Remote Area Medical, bore testament to the human cost of the healthcare mess that President Obama is attempting to fix.

Christine Smith arrived at 3am in the hope of seeing a dentist for the first time since she turned 18. That was almost eight years ago. Her need is obvious and pressing: 17 of her teeth are rotten; some have large visible holes in them. She is living in constant pain and has been unable to eat solid food for several years.

"I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I've had several jobs since, but none with medical insurance, so I've not been able to see a dentist to get it fixed," she told The Independent. "I've not been able to chew food for as long as I can remember. I've been living on soup, and noodles, and blending meals in a food mixer. I'm in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I'll do it. This will change my life."

Along the hall, Liz Cruise was one of scores of people waiting for a free eye exam. She works for a major supermarket chain but can't afford the $200 a month that would be deducted from her salary for insurance. "It's a simple choice: pay my rent, or pay my healthcare. What am I supposed to do?" she asked. "I'm one of the working poor: people who do work but can't afford healthcare and are ineligible for any free healthcare or assistance. I can't remember the last time I saw a doctor."

Although the Americans spend more on medicine than any nation on earth, there are an estimated 50 million with no health insurance at all. Many of those who have jobs can't afford coverage, and even those with standard policies often find it doesn't cover commonplace procedures. California's unemployed – who rely on Medicaid – had their dental care axed last month.

Julie Shay was one of the many, waiting to slide into a dentist's chair where teeth were being drilled in full view of passers-by. For years, she has been crossing over the Mexican border to get her teeth done on the cheap in Tijuana. But recently, the US started requiring citizens returning home from Mexico to produce a passport (previously all you needed was a driver's license), and so that route is now closed. Today she has two abscesses and is in so much pain she can barely sleep. "I don't have a passport, and I can't afford one. So my husband and I slept in the car to make sure we got seen by a dentist. It sounds pathetic, but I really am that desperate."

"You'd think, with the money in this country, that we'd be able to look after people's health properly," she said. "But the truth is that the rich, and the insurance firms, just don't realise what we are going through, or simply don't care. Look around this room and tell me that America's healthcare don't need fixing."

President Obama's healthcare plans had been a central plank of his first-term programme, but his reform package has taken a battering at the hands of Republican opponents in recent weeks. As the Democrats have failed to coalesce around a single, straightforward proposal, their rivals have seized on public hesitancy over "socialised medicine" and now the chance of far-reaching reform is in doubt.

Most damaging of all has been the tide of vociferous right-wing opponents whipping up scepticism at town hall meetings that were supposed to soothe doubts. In Pennsylvania this week, Senator Arlen Specter was greeted by a crowd of 1,000 at a venue designed to accommodate only 250, and of the 30 selected speakers at the event, almost all were hostile.

The packed bleachers in the LA Forum tell a different story. The mobile clinic has been organised by the remarkable Remote Area Medical. The charity usually focuses on the rural poor, although they worked in New Orleans after Hurricane Katrina. Now they are moving into more urban venues, this week's event in Los Angeles is believed to be the largest free healthcare operation in the country.

Doctors, dentists and therapists volunteer their time, and resources to the organisation. To many US medical professionals, it offers a rare opportunity to plug into the public service ethos on which their trade was supposedly founded. "People come here who haven't seen a doctor for years. And we're able to say 'Hey, you have this, you have this, you have this'," said Dr Vincent Anthony, a kidney specialist volunteering five days of his team's time. "It's hard work, but incredibly rewarding. Healthcare needs reform, obviously. There are so many people falling through the cracks, who don't get care. That's why so many are here."

Ironically, given this week's transatlantic spat over the NHS, Remote Area Medical was founded by an Englishman: Stan Brock. The 72-year-old former public schoolboy, Taekwondo black belt, and one-time presenter of Wild Kingdom, one of America's most popular animal TV shows, left the celebrity gravy train in 1985 to, as he puts it, "make people better".

Today, Brock has no money, no income, and no bank account. He spends 365 days a year at the charity events, sleeping on a small rolled-up mat on the floor and living on a diet made up entirely of porridge and fresh fruit. In some quarters, he has been described, without too much exaggeration, as a living saint.

Though anxious not to interfere in the potent healthcare debate, Mr Brock said yesterday that he, and many other professionals, believes the NHS should provide a benchmark for the future of US healthcare.

"Back in 1944, the UK government knew there was a serious problem with lack of healthcare for 49.7 million British citizens, of which I was one, so they said 'Hey Mr Nye Bevan, you're the Minister for Health... go fix it'. And so came the NHS. Well, fast forward now 66 years, and we've got about the same number of people, about 49 million people, here in the US, who don't have access to healthcare."

"I've been very conservative in my outlook for the whole of my life. I've been described as being about 90,000 miles to the right of Attila the Hun. But I think one reaches the reality that something doesn't work... In this country something has to be done. And as a proud member of the US community but a loyal British subject to the core, I would say that if Britain could fix it in 1944, surely we could fix it here in America.

Healthcare compared

Health spending as a share of GDP

US 16%
UK 8.4%

Public spending on healthcare (% of total spending on healthcare)

US 45%
UK 82%

Health spending per head

US $7,290
UK $2,992

Practising physicians (per 1,000 people)

US 2.4
UK 2.5

Nurses (per 1,000 people)

US 10.6
UK 10.0

Acute care hospital beds (per 1,000 people)

US 2.7
UK 2.6

Life expectancy:

US 78
UK 80

Infant mortality (per 1,000 live births)

US 6.7
UK 4.8

Tuesday, August 18, 2009

Dear President Obama: A Modest Medicare Proposal

Original Link:

By Thom Hartmann

Dear President Obama,

I understand you're thinking of dumping your "public option" because of all the demagoguery by Sarah Palin and Dick Armey and Newt Gingrich and their crowd on right-wing radio and Fox. Fine. Good idea, in fact.

Instead, let's make it simple. Please let us buy into Medicare.

It would be so easy. You don't have to reinvent the wheel with this so-called "public option" that's a whole new program from the ground up. Medicare already exists. It works. Some people will like it, others won't -- just like the Post Office versus FedEx analogy you're so comfortable with.

Just pass a simple bill -- it could probably be just a few lines, like when Medicare was expanded to include disabled people -- that says that any American citizen can buy into the program at a rate to be set by the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) which reflects the actual cost for us to buy into it.

So it's revenue neutral!

To make it available to people of low income, raise the rates slightly for all currently non-eligible people (like me -- under 65) to cover the cost of below-200%-of-poverty people. Revenue neutral again.

Most of us will do damn near anything to get out from under the thumbs of the multi-millionaire CEOs who are running our current insurance programs. Sign me up!

This lets you blow up all the rumors about death panels and grandma and everything else: everybody knows what Medicare is. Those who scorn it can go with Blue Cross. Those who like it can buy into it. Simplicity itself.

Of course, we'd like a few fixes, like letting Medicare negotiate drug prices and filling some of the holes Republicans and AARP and the big insurance lobbyists have drilled into Medicare so people have to buy "supplemental" insurance, but that can wait for the second round. Let's get this done first.

Simple stuff. Medicare for anybody who wants it. Private health insurance for those who don't. Easy message. Even Max Baucus and Chuck Grassley can understand it. Sarah Palin can buy into it, or ignore it. No death panels, no granny plugs, nothing. Just a few sentences.

Replace the "you must be disabled or 65" with "here's what it'll cost if you want to buy in, and here's the sliding scale of subsidies we'll give you if you're poor, paid for by everybody else who's buying in." (You could roll back the Reagan tax cuts and make it all free, but that's another rant.)

We elected you because we expected you to have the courage of your convictions. Here's how. Not the "single payer Medicare for all" that many of us would prefer, but a simple, "Medicare for anybody who wants to buy in."


Thom Hartmann

Sunday, August 16, 2009

Keep Corporate Money Out of Elections

Original Link:


The founders were wary of corporate influence on politics — and their rhetoric sometimes got pretty heated. In an 1816 letter, Thomas Jefferson declared his hope to “crush in its birth the aristocracy of our moneyed corporations, which dare already to challenge our government to a trial of strength and bid defiance to the laws of our country.”

This skepticism was enshrined in law in the early 20th century when the nation adopted strict rules banning corporations from contributing to political campaigns. Today that ban is in danger from the Supreme Court, which hears arguments next month in a little-noticed case that could open the floodgates to corporate money in politics.

The court has gone to extraordinary lengths to hear the case. And there are worrying signs that there may well be five votes to rule that the ban on corporate contributions violates the First Amendment.

The origins of the ban lie in the 1896 presidential race, which pitted the Republican William McKinley against William Jennings Bryan, the farm-belt populist. Bryan was a peerless orator, but McKinley had Mark Hanna — the premier political operative of his day — extracting so-called assessments from the nation’s biggest corporations and funneling them into a vast marketing campaign.

McKinley, who outspent Bryan by an estimated 10 to 1, won handily, proving Hanna’s famous dictum: “There are two things that are important in politics. The first is money, and I can’t remember what the second one is.”

Popular outrage over corporate contributions reached a high point in the 1904 election.

The defeated candidate, the Democrat Alton Parker, charged — accurately, it turned out — that his opponent had been bankrolled by large life insurance companies. “The greatest moral question which now confronts us is,” Parker insisted, “shall the trusts and corporations be prevented from contributing money to control or aid in controlling elections?”

In 1907, Congress passed the Tillman Act, the first federal law barring corporate campaign contributions. States adopted similar laws.

Since then, Congress has repeatedly ratified the federal ban. In 1925, it folded the Tillman Act into the Federal Corrupt Practices Act. In 1947, it made clear that the ban included not just corporate contributions, but corporate expenditures on campaigns — and that it also applied to labor unions. In the 2002 McCain-Feingold law, Congress once again underscored that corporations cannot contribute to campaigns.

It is inconceivable that Congress would now try to lift the ban. Americans are far too angry at Wall Street and the obvious failure of government regulations. But the Supreme Court has decided to force the question: It took a case, Citizens United v. Federal Election Commission, in which the ban on corporate contributions was not a central issue; told the parties to prepare legal briefs on the ban’s constitutionality; and rushed to put oral arguments on the calendar in September before the new term even starts.

The court’s conservative majority has been aggressively championing the rights of corporations, but overturning the contributions ban would take it to a new level. Corporations have enormous treasuries, and there are a lot of things they want from government, many of which clash with the public interest.

If the ban is struck down, corporations may soon be writing large checks to the same elected officials whom they are asking to give them bailouts or to remove health-and-safety regulations from their factories or to insert customized loopholes into the tax code.

If the conservative justices strike down the ban, they would be doing many things they disavow. They would be substituting their own views for the will of the people, expressed through Congress. They would be reading rights into the Constitution that are not expressly there, since the Constitution never mentions corporations or their right to speak. And they would be overturning the court’s own precedents.

The only hope is that the court is listening to Americans. As it weighs the constitutional issues, it should be mindful that this is another historical moment in which the public is committed to strengthening the wall between government and big business, not tearing it down.

The "death panels" are already here

Original Link:

By Mike Madden

Sorry, Sarah Palin -- rationing of care? Private companies are already doing it, with sometimes fatal results

The future of healthcare in America, according to Sarah Palin, might look something like this: A sick 17-year-old girl needs a liver transplant. Doctors find an available organ, and they're ready to operate, but the bureaucracy -- or as Palin would put it, the "death panel" -- steps in and says it won't pay for the surgery. Despite protests from the girl's family and her doctors, the heartless hacks hold their ground for a critical 10 days. Eventually, under massive public pressure, they relent -- but the patient dies before the operation can proceed.

It certainly sounds scary enough to make you want to go show up at a town hall meeting and yell about how misguided President Obama's healthcare reform plans are. Except that's not the future of healthcare -- it's the present. Long before anyone started talking about government "death panels" or warning that Obama would have the government ration care, 17-year-old Nataline Sarkisyan, a leukemia patient from Glendale, Calif., died in December 2007, after her parents battled their insurance company, Cigna, over the surgery. Cigna initially refused to pay for it because the company's analysis showed Sarkisyan was already too sick from her leukemia; the liver transplant wouldn't have saved her life.

That kind of utilitarian rationing, of course, is exactly what Palin and other opponents of the healthcare reform proposals pending before Congress say they want to protect the country from. "Such a system is downright evil," Palin wrote, in the same message posted on Facebook where she raised the "death panel" specter. "Health care by definition involves life and death decisions."

Coverage of Palin's remarks, and former House Speaker Newt Gingrich's defense of them, over the weekend did point out that the idea that the reform plans would encourage government-sponsored euthanasia is one of a handful of deliberate falsehoods being peddled by opponents of the legislation. But the idea that only if reform passes would the government start setting up rationing and interfering with care goes beyond just the bogus euthanasia claim.

Opponents of reform often seem to skip right past any problems with the current system -- but it's rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren't required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member's medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren't immune to difficulty.

"You're asking us to decide that the government is to be trusted," Gingrich -- who may, like Palin, be running for the GOP's presidential nomination in 2012 -- told ABC's "This Week With George Stephanopoulos" on Sunday. But as even a quick glance through news coverage of the last few years shows, private insurers are already doing what reform opponents say they want to save us from. (The insurance industry, pushing back against charges that they're part of the problem, said last month that "healthcare reform is far too important to be dragged down by divisive political rhetoric." The industry has long maintained that its decisions on what to cover are the result of careful investigations of each claim.) Here is a look at a handful of healthcare horror stories, brought to you by the current system. It took Salon staff less than an hour to round these up -- which might indicate how many other such stories are out there.

-- In June 2008, Robin Beaton, a retired nurse from Waxahachie, Texas, found out she had breast cancer and needed a double mastectomy. Two days before her surgery, her insurance company, Blue Cross, flagged her chart and told the hospital they wouldn't allow the procedure to go forward until they finished an examination of five years of her medical history -- which could take three months. It turned out that a month before the cancer diagnosis, Beaton had gone to a dermatologist for acne treatment, and Blue Cross incorrectly interpreted a word on her chart to mean that the acne was precancerous.

Not long into the investigation, the insurer canceled her policy. Beaton, they said, had listed her weight incorrectly when she bought it, and had also failed to disclose that she'd once taken medicine for a heart condition -- which she hadn't been taking at the time she filled out the application. By October, thanks to an intervention from her member of Congress, Blue Cross reinstated Beaton's insurance coverage. But the tumor she had removed had grown 2 centimeters in the meantime, and she had to have her lymph nodes removed as well as her breasts amputated because of the delay.

-- In October 2008, Michael Napientak, a doorman from Clarendon Hills, Ill., went to the hospital for surgery to relieve agonizing back pain. His wife's employer's insurance provider, a subsidiary of UnitedHealthCare, had issued a pre-authorization for the operation. The operation went well. But in April, the insurer started sending notices that it wouldn't pay for the surgery, after all; the family, not the insurance provider, would be on the hook for the $148,000 the hospital charged for the procedure. Pre-authorization, the insurance company explained, didn't necessarily guarantee payment on a claim would be forthcoming. The company offered shifting explanations for why it wouldn't pay -- first, demanding proof that Napientak had tried less expensive measures to relieve his pain, and then, when he provided it, insisting that it lacked documentation for why the surgery was medically necessary. Napientak's wife, Sandie, asked her boss to help out, but with no luck. Fortunately for the Napientaks, they were able to attract the attention of a Chicago Tribune columnist before they had to figure out how to pay the six-figure bill -- once the newspaper started asking questions, the insurer suddenly decided, "based on additional information submitted," to cover the tab, after all.

-- David Denney was less than a year old when he was diagnosed in 1995 with glutaric acidemia Type 1, a rare blood disorder that left him severely brain damaged and unable to eat, walk or speak without assistance. For more than a decade, Blue Cross of California -- his parents' insurance company -- paid the $1,200 weekly cost to have a nurse care for him, giving him exercise and administering anti-seizure medication.

But in March 2006, Blue Cross told the Denney family their claims had exceeded the annual cost limit for his care. When they wrote back, objecting and pointing out that their annual limit was higher, the company changed its mind -- about the reason for the denial. The nurse's services weren't medically necessary, the insurers said. His family sued, and the case went to arbitration, as their policy allowed. California taxpayers, meanwhile, got stuck with the bill -- after years of paying their own premiums, the Denney family went on Medi-Cal, the state's Medicaid system.

-- Patricia Reilling opened an art gallery in Louisville, Ky., in 1987, and three years later took out an insurance policy for herself and her employees. Her insurance provider, Anthem Health Plans of Kentucky, wrote to her this June, telling her it was canceling her coverage -- a few days after it sent her a different letter detailing the rates to renew for another year and billing her for July.

Reilling thinks she knows the reason for the cutoff, though -- she was diagnosed with breast cancer in March 2008. That kicked off a year-long battle with Anthem. First the company refused to pay for an MRI to locate the tumors, saying her family medical history didn't indicate she was likely to have cancer. Eventually, it approved the MRI, but only after she'd undergone an additional, painful biopsy. Her doctor removed both of her breasts in April 2008. In December, she went in for reconstructive plastic surgery -- and contracted a case of MRSA, an invasive infection. In January of this year, Reilling underwent two more surgeries to deal with the MRSA infection, and she's likely to require another operation to help fix all the damage. The monthly bill for her prescription medicines -- which she says are mostly generics -- is $2,000; the doctors treating her for the MRSA infection want $280 for each appointment, now that she's lost her insurance coverage. When she appealed the decision to cancel her policy, asking if she could keep paying the premium and continue coverage until her current course of treatment ends, the insurers wrote back with yet another denial. But they did say they hoped her health improved.

The Real Death Panels

Original Link:

By Joe Conason

When Republican politicians and right-wing talking heads bemoan the fictitious "death panels" that they claim would arise from health-care reform, they are concealing a sinister reality from their followers. The ugly fact is that every year we fail to reform the existing system, that failure condemns tens of thousands of people to die — either because they have no insurance or because their insurance companies deny coverage or benefits when they become ill.

The best estimate of the annual death toll among Americans of working age due to lack of insurance or under-insurance is at least 20,000, according to studies conducted over the past decade by medical researchers, and is almost certainly rising as more and more people lose their coverage as costs continue to go up.

They die primarily because they didn't have the coverage or the money to pay doctors and thus delayed seeking treatment until it was too late. They don't get checkups, screenings and other preventive care. That is why uninsured adults are far more likely to be diagnosed with a disease, such as cancer or heart disease, at an advanced stage, which severely reduces their chances of survival.

This isn't news. Seven years ago, the Institute of Medicine found that approximately 18,000 Americans had died in 2000 because they had no insurance. Using the same methodology combined with Census Bureau estimates of health coverage, the Urban Institute concluded that the incidence of death among the uninsured was enormous. Between 2000 and 2006, the last year of that study, the total number of dead was estimated to have reached 137,000 — a body count more than double the number of casualties in the Vietnam War.

The Institute of Medicine also found that uninsured adults are 25 percent more likely to die prematurely than adults with private health insurance, and other studies have warned that uninsured adults between the ages of 55 and 64 are even more prone to die prematurely. A lack of health insurance is the third-leading cause of death for that age cohort, following heart disease and cancer.

All those appalling figures, which are real rather than mythical, do not include the casualties of insurance company profiteering — namely, all the people, including small children, who perish because of the anonymous "death panels" that deny or delay coverage to consumers.

Perhaps the most notorious case in recent years was that of Nataline Sarkisyan, the 17-year-old leukemia patient whose liver transplant was held up by insurance giant Cigna HealthCare.
She died for no reason except to protect Cigna's profit margin, but her unnecessary and cruel demise was hardly unique.

Research by the American Medical Association found that the nation's largest insurance companies deny somewhere between 2 percent and 5 percent of all the claims submitted by doctors. That rough estimate is the best available because private insurers are not required to reveal such statistics (although they certainly maintain them), and the government does not collect them.

But in June, a House Energy and Commerce Committee investigation found that three major insurance companies — Golden Rule, Assurant and WellPoint — rescinded the coverage of at least 20,000 people between 2003 and 2007 for minor errors, including typos, on their paperwork; a pre-existing condition; or a family member's medical history.

"They try to find something — anything — so they can say that this individual was not truthful," said Rep. Henry Waxman, the California Democrat who oversaw the committee probe. He warned that insurance companies launch these nitpicking inquisitions whenever a policyholder becomes ill with a certain kind of condition — usually a costly and deadly one, such as ovarian cancer or leukemia. The result is denial and loss of coverage — and we now know that means increased mortality for innocent people.

So, who are the members of the death panels?

You can find them among the corporate bureaucrats who concoct excuses to deny coverage and throw the sick off their rolls. You can find them among the politicians and lobbyists who have stalled reform for years while people died. You can find them among the morons who show up to shout slogans at town halls rather than seek solutions. And you can find them among the cable and radio blabbers, who invent scary stories about reform to conceal the sickening truth.

Saturday, August 15, 2009

Republican Death Trip

Original Link:


“I am in this race because I don’t want to see us spend the next year re-fighting the Washington battles of the 1990s. I don’t want to pit Blue America against Red America; I want to lead a United States of America.” So declared Barack Obama in November 2007, making the case that Democrats should nominate him, rather than one of his rivals, because he could free the nation from the bitter partisanship of the past.

Some of us were skeptical. A couple of months after Mr. Obama gave that speech, I warned that his vision of a “different kind of politics” was a vain hope, that any Democrat who made it to the White House would face “an unending procession of wild charges and fake scandals, dutifully given credence by major media organizations that somehow can’t bring themselves to declare the accusations unequivocally false.”

So, how’s it going?

Sure enough, President Obama is now facing the same kind of opposition that President Bill Clinton had to deal with: an enraged right that denies the legitimacy of his presidency, that eagerly seizes on every wild rumor manufactured by the right-wing media complex.

This opposition cannot be appeased. Some pundits claim that Mr. Obama has polarized the country by following too liberal an agenda. But the truth is that the attacks on the president have no relationship to anything he is actually doing or proposing.

Right now, the charge that’s gaining the most traction is the claim that health care reform will create “death panels” (in Sarah Palin’s words) that will shuffle the elderly and others off to an early grave. It’s a complete fabrication, of course. The provision requiring that Medicare pay for voluntary end-of-life counseling was introduced by Senator Johnny Isakson, Republican — yes, Republican — of Georgia, who says that it’s “nuts” to claim that it has anything to do with euthanasia.

And not long ago, some of the most enthusiastic peddlers of the euthanasia smear, including Newt Gingrich, the former speaker of the House, and Mrs. Palin herself, were all for “advance directives” for medical care in the event that you are incapacitated or comatose. That’s exactly what was being proposed — and has now, in the face of all the hysteria, been dropped from the bill.

Yet the smear continues to spread. And as the example of Mr. Gingrich shows, it’s not a fringe phenomenon: Senior G.O.P. figures, including so-called moderates, have endorsed the lie.

Senator Chuck Grassley, Republican of Iowa, is one of these supposed moderates. I’m not sure where his centrist reputation comes from — he did, after all, compare critics of the Bush tax cuts to Hitler. But in any case, his role in the health care debate has been flat-out despicable.

Last week, Mr. Grassley claimed that his colleague Ted Kennedy’s brain tumor wouldn’t have been treated properly in other countries because they prefer to “spend money on people who can contribute more to the economy.” This week, he told an audience that “you have every right to fear,” that we “should not have a government-run plan to decide when to pull the plug on grandma.”

Again, that’s what a supposedly centrist Republican, a member of the Gang of Six trying to devise a bipartisan health plan, sounds like.

So much, then, for Mr. Obama’s dream of moving beyond divisive politics. The truth is that the factors that made politics so ugly in the Clinton years — the paranoia of a significant minority of Americans and the cynical willingness of leading Republicans to cater to that paranoia — are as strong as ever. In fact, the situation may be even worse than it was in the 1990s because the collapse of the Bush administration has left the G.O.P. with no real leaders other than Rush Limbaugh.

The question now is how Mr. Obama will deal with the death of his postpartisan dream.

So far, at least, the Obama administration’s response to the outpouring of hate on the right has had a deer-in-the-headlights quality. It’s as if officials still can’t wrap their minds around the fact that things like this can happen to people who aren’t named Clinton, as if they keep expecting the nonsense to just go away.

What, then, should Mr. Obama do? It would certainly help if he gave clearer and more concise explanations of his health care plan. To be fair, he’s gotten much better at that over the past couple of weeks.

What’s still missing, however, is a sense of passion and outrage — passion for the goal of ensuring that every American gets the health care he or she needs, outrage at the lies and fear-mongering that are being used to block that goal.

So can Mr. Obama, who can be so eloquent when delivering a message of uplift, rise to the challenge of unreasoning, unappeasable opposition? Only time will tell.

Oh, Those Death Panels

Original Link:

By Amy Sullivan

You would think that if Republicans wanted to totally mischaracterize a health care provision and demagogue it like nobody's business, they would at least pick something that the vast majority of them hadn't already voted for just a few years earlier. Because that's not just shameless, it's stupid.

Yes, that's right. Remember the 2003 Medicare prescription drug bill, the one that passed with the votes of 204 GOP House members and 42 GOP Senators? Anyone want to guess what it provided funding for? Did you say counseling for end-of-life issues and care? Ding ding ding!!

Let's go to the bill text, shall we? "The covered services are: evaluating the beneficiary's need for pain and symptom management, including the individual's need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning." The only difference between the 2003 provision and the infamous Section 1233 that threatens the very future and moral sanctity of the Republic is that the first applied only to terminally ill patients. Section 1233 would expand funding so that people could voluntarily receive counseling before they become terminally ill.

So either Republicans were for death panels in 2003 before turning against them now--or they're lying about end-of-life counseling in order to frighten the bejeezus out of their fellow citizens and defeat health reform by any means necessary. Which is it, Mr. Grassley ("Yea," 2003)?

Death Panels Already Exist, They are Called Corporate Health Insurance Bureaucrats

Original Link:

by Grant Lawrence

...."never once did I have a Medicare bureaucrat tell me what I couldn't do for a patient, but all the time we have bureaucrats from the insurance companies calling up and saying we're not going to cover this, we're not going to pay for that, we're denying coverage for that. The system we have now is broken. We need to fix it."
Dr. Howard Dean, former Democratic Presidential Candidate and former DNC Chairman.

The most intrusive system to life-saving medical care is already occurring. Doctors daily have to contend with the regulation on their medical practice by the Health Insurance Industry that decides what treatment is acceptable for payment.

So while former Republican VP candidate Sarah Palin has called President Obama's health plan "evil" because it may lead to "death panels" that decide who gets to live and die. Unfortunately, we already have these death panels and they are insurance company executives that decide who will get to live and die based upon what they will pay for.

The absurdity of the rationale in which it is all right for a person to live or die based upon whether they have good health insurance, but it isn't all right for all people to have access to health care because the government might be involved is a type of American madness.

Americans have been conditioned for so many years to see the government as the enemy but never to question their own slavery to the Financial and Corporate interests that run America.

The real enemy is the not-so-invisible hand of Financial and Corporate power that not only calls the shots on who gets to live and die, but also gets to call the shots on how well Americans live and the way in which they will live.

The money system that has corrupted the American psyche to its very core views any form of care and help for others as a threat to the welfare of America. This allows for the fear mongering of near lunatics like Sarah Palin and the unbelievable willingness of many Americans to accept the insanity.

We presently have a system in which a hundred million Americans either have no insurance or are under-insured and that system determines who lives and dies daily. On top of that, we have a health care system in which insurance company bureaucrats routinely make life and death decisions that deny coverage and Americans think this is freedom.

Until Americans start moving beyond the propaganda of their corporate masters, they will continue to be enslaved to a system that will not tolerate humane treatment of people. Americans must move beyond the indoctrinated Corporate madness by "trusted" lunatics, like Palin, and into sanity. Their very lives depend on it.