Market-Based Health Folly

I just received, and read, my first issue of The Progressive Populist. I am not "plugged in" to the Internet, but, for over a decade now, I have been plugged in to many of the issues you discuss with the result that I voted for Ralph Nader in the last three presidential elections.

One of the main things I have come to understand is that the issue of market fundamentalism, as discussed by Ruth Rosen ("Challenge Market Fundamentalism," 3/1/07 TPP), is indeed one of the most, if not the most, important issue that progressives must deal with. A subset of this mythology is the requirement that the "business model" must be applied to all our endeavors, i.e. that it is always necessary to "increase revenue and decrease overhead," so that, at the very least, such endeavors should be "revenue neutral" -- all activities and, by definition, the institutions through which these activities are actualized, should pay for themselves. And if they cannot, they will suffer the fate the market dictates for such "failures" -- termination.

As applied to health care, as it is now, the end results of throwing health-care institutions, such as hospitals, to the wolves of the market are a series of absurdities.

To wit: To increase revenue they are told they must "compete" with other health care institutions to increase their "market share" -- of sick people! -- who are no longer patients but "customers" or "health care consumers' and in this competition for "business" they are forced to spend precious health care dollars on, of all things, advertising! And they must have all the latest gadgets so they can lure in the "customers." But none but the very richest of these customers can actually pay for health care because it is a very expensive thing to provide (partially, ironically, because of the cost of all the gadgets institutions need to "compete"), so the revenue must come from employer-based private insurance companies or public funding, all of which revenue is decreasing steadily with no end in sight.

Failing to be able to increase revenue, to stay afloat these institutions must decrease overhead. And the biggest source of overhead for a business? Why labor, of course. So staffing is being cut because there is no money for it and the ones who are left are working extra shifts, double shifts, even mandatory overtime.

When you try to put the square peg of health care into the round hole of market-based business, you have to cut so many corners that the institutions bleed to death. The end result is that health care in this country is on life support. The only reason it is still breathing is because of the extraordinary dedication of the staff, but even these folk have their limits. They are getting very tired and under this absurd model, seeing no end in sight, they are leaving.

Until we understand that one of the first discussions we must have is about which endeavors are suitable for the market business model and which are not and, perhaps more importantly, why this is so, we will not be able to articulate the reasons why we need, for example, a national single-payer health-care plan, wherein we acknowledge that health care for all is an absolute social responsibility, not a business endeavor; provided on the basis of need contingent upon an individual's or a healthcare facility's ability to pay for him/itself. In other words, why Market Rules have no place here.

I hope you will use your publication to help us have this discussion so that we will have the tools we need to dispel this overarching myth Ms. Rosen speaks of so well. She is absolutely right; until we dethrone this value system as "The Model" for all of human activity we will make no progress toward realizing a Progressive vision of our lives. Let the discussion begin!

Sue Hammond, MD
North Syracuse, N.Y.

P.S. Two excellent tools for this discussion vis-a-vis health care are Bleeding the Patient by D. Himmelstein, S. Woolhandler and I. Hellander, MDs, and As Sick As It Gets by R. Mueller, MD.


Chavez No Tinpot

Re: "Time to Get Serious," by Art Cullen, 3/1/07 TPP: Et tu Brute? Another passenger (who should know better) hopping on the Chavez-bashing train.

Tinpot dictator? As dictators go (especially democratically elected ones), Chavez is pretty tame. Dissidents aren't disappearing or being murdered a la the Pinochet regime. Chavez's government controls much state-run media, but hey, our "free" US press might as well be government-controlled, given how misinformed and uninformed they keep the public.

Chavez uses Venezuelan oil money to improve life for his country's masses, not just the rich minority -- something past leaders cared little about doing. Improved living standards lead to a more stable country and less civil strife. More important, it means less immigrants (legal or otherwise) seeking greener pastures in the US. If only Mexico would take notice -- its government seems content to sign one-sided trade pacts and send its poor, tired, and hungry to the US for jobs, and, to reap the millions in remittances wired back across the border.

US politicians (both parties), corporations, and media sycophants hate Chavez because he won't allow our government and corporate interests to loot Venezuelan resources without paying a fair price to the country's people -- especially the Afro-Latino and indigenous masses who comprise a large part of the population.

As for Chavez's anti-US rhetoric, his venom is aimed at Bush, not average Americans. The Bush administration has been trying to oust the guy ever since he got elected. Politicians and pundits continue a disinformation/smear campaign against Chavez constantly, with scant opposition from prominent left-leaning media and Democrats.

Is every Chavez idea, policy, or program going splendidly? No. Is his anti-Bush ranting over the top? Sometimes. But at least Chavez is trying to use his power to better life for those Venezuelans who've been ignored and exploited for decades. In addition, he's trying to unite Latin American countries to better utilize their clout to strengthen the region economically. That's more that can be said for our government which for the past 20 years has moved from its responsibility to attend to the best interests of all the people to attending to the best interests of the monied few.

Beverly Rice
Charlotte, N.C.


Issues Taken

In your 3/1/07 TPP column ["Time to Get Serious," by Art Cullen], you made two statements that I must take issue with.

First, without any citation or attribution, you stated that "ethanol actually generates 60% more power than it consumes." In the context of the article, it appears you were talking about corn-based ethanol. This assertion contradicts several other articles I have read on this subject in recent months. It appears to me that virtually every scientist who is not on the payroll of the USDA or agribusiness has concluded that corn-based ethanol is neither energy efficient nor environmentally friendly. 

A recent article in the Jo Daviess County Natural Area Guardians Messenger by Robert Wehrle stated "Growing corn consumes large amounts of fossil fuels. Corn consumes more synthetic fertilizer than any other crop, and the fertilizer is made from oil and natural gas. Corn also requires more pesticide than other crops, and the pesticides are made from petroleum. Diesel fuel is required to plant the seed, spray the corn with fertilizer and pesticides, and harvest the corn. Finally, drying the corn requires large amounts of natural gas or other fossil fuels. It has been estimated that the equivalent of between one third and one half of a gallon of gasoline is required for each bushel of corn grown. Then there is the energy required to distill the corn into ethanol. ... When the energy required to grow the corn is added in, several experts estimate that it may actually take more than a gallon of fossil fuel energy to produce a gallon of ethanol from corn."

If you have any evidence to refute these findings or to support your assertion about "60% more power," I would like to see it.

The other statement you made that troubled me was when you called Hugo Chavez of Venezuela a "tinpot dictator." Unlike Presidents Clinton and Bush, Mr. Chavez has been elected and re-elected by large majorities in free and fair elections. He has used his nation's oil wealth to provide health, education and welfare for his own people, as well as providing free fuel for a lot of poor people in New England. If that's a "tinpot dictator," I wish we had one.

Steve McGuire
Galena, Ill.


Thank You, Molly Ivins

And thank you, Jim Cullen, for bringing Molly to us in The Progressive Populist.

What was so special and valuable about Molly Ivins was that she looked squarely in the face of evil threatening power, of state and corporate intimidation and corruption, of the authors of intentional injustice and unspeakable cruelty and terror. Next, she pointed right at it so we could see it for what it really was. And then she laughed out loud. She didn't turn away and pretend that she just didn't see, like too many people seem to do. She didn't look around for a safer distraction for her creative juices. She didn't divert her stare or dim her spotlight. And when she had it in her glare for us to see, she did it. She laughed! Leaving us with the certainty of hope, rather than a depressing sense of futility.

Not many others could do that. Of those, only a very few did it well. And Molly did it more exuberantly, more outrageously, than anyone else ever did. Gallows humor in newsprint. I think maybe Molly did it the best.

But it's not just a clever technique. It took courage. And that gives US courage.

Someone fortunate enough to know Molly personally once asked her when she was going to get serious. Ms. Ivins reportedly replied that she would get serious when we finally stood a chance of winning.

To look at, and illuminate, terrible reality, and laugh at it, takes courage, and was the basis for Ms. Ivins' genius.

Thank you, Molly Ivins.

Clyde Winter
Grafton, Wis.


Hard to Read

It has taken me longer to read this issue than any previous ones; it's very difficult to read when tears well up, and they certainly have done so while reading the tributes to Molly. No one can replace her, so whatever shall we do without her to spur us along and inform us with such great skill and humor. Who will pick up the torch? Rhetorical questions, to be sure, but the ones that keep pushing themselves into my thoughts.

Keep on keepin' on,

Patricia Kirkegaard
Sioux City, Iowa


Yesterday's Heroes

There's a national disgrace! No, it's not Abu Ghraib. It's most graphically revealed in Building 18. It's everyone who has anything to do with the medical care of our physically and mentally wounded and maimed soldiers from the war raging on without end in Iraq and Afghanistan. Yes, our mentally wounded are maimed, too.

Everyone who's not been asleep for the past few weeks should be aware of the significance of Building 18, the "rehabilitation center" at Walter Reed Hospital in Washington, D.C. Its rat-infested, paint-peeling, mold-covered walls are where the medical staff of one of the finest hospitals in the United States sends our severely injured soldiers to wait for further rehabilitation.

And our poor, uninformed members of Congress are exhibiting anger upon learning this. They want an investigation! Where were they before this bombshell exploded on the public scene? The quality of care for our wounded should have been a priority in their oversight of the Department of Defense. I'm not impressed by their crocodile tears at this late date.

(I have added a copy of the poem, "Tommy," by Rudyard Kipling, that tells how the British treated their G.I.s in the 19th century and is a fair description of how we are treating ours in 2007 ...)

Percy Pascoe
Cuba, Mo.


Photos of War

I note almost daily the faces of Iraqis or those unfortunates from Afghanistan whose families or friends have been wiped out in a burst of so-called "collateral damage," followed by the inevitable apology or in most cases an explanation from the US HQ that the civilians were caught in crossfire between the troops and the militants as if any excuse will take away the horror and profound pain and trauma of knowing about or, in many cases, witnessing the instant death and probable dismemberment of innocents. Repeated cycles -- killing of the innocents and instant apologies -- carry further the seeds of mistrust and intense desire of revenge by Iraqis to our occupation. At the same time this repeated cycle of killing of innocents may have a different and paradoxically mollifying effect on our troops. Though our troops also have an attitude of mistrust and hatred which encourage further cycles, their reactions are different from those of the Iraqi because these deaths are seen by the army as "collateral damage" expected and excusable in warfare. I believe that troops therefore may be shielded from the effect of civilian deaths by internalizing an attitude of psychic numbing that tends to justify and wipe out concern for participating in these cycles.

Sid Moss
Elkins Park, Pa.



Blog after blog comes in telling about the debts piling up at the Governmental level. One says $6 trillion and another says we in the laity are being lied to again, that the debt is several times six trillion. Either way it is forbidding. And why is it like that?

There is only one answer, government mismanagement. Now Mr. Editor, let's be logical. It started with the Bush administration and this is fact, not Bushwhacking. Texas started down the day Bush said "cut taxes" and continued the day he took the presidency of a debt-free America, leading it into its present deplorable condition hated by all the World. The last election showed an awakening and once again there is hope instead of hopelessness; truth instead of lies.

Everett L. Williams
Ingram, Texas

From The Progressive Populist, April 1, 2007

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