North Carolina Man Desperately Commits a Crime in attempt to get Prison Health Care
When I look at this man I don’t see a Criminal I see a Desperate Sick Man who is trying to Survive and possibly save his Life. His eyes are sad showing a life that has suffered and is struggling. Many news stations were telling his story, but they kept focusing on his alleged “Crime” , and making accusations or even joking questioning his Sanity. Not one station reported his situation for the Crisis it is. And Truthfully maybe it is a Crime that we don’t have Health care for All at this point, for if we did he would not have had to choose the Path he chose…..
Let’s Learn more about this man and what led to his “Crime”. Richard James Verome is 59 years old. He worked for Coca Cola for over 17 years as a Delivery Driver taking care of his customers. Three years ago he was laid off, and since then he has struggled to find work and keep a roof over his head. He finally found part time work at a convenience store. But the long hours standing and the lifting led to Health problems. His back was developing disc problems and he was experiencing arthritis and problems with his left foot. But when he noticed a protuberance growing on his chest, he realized that this growth may be severe, even life threatening. But for the past 3 years there had been no Health care for any of these issues, and this new issue made him realize that he needed Some Kind of Healthcare.
James Verome had never had complaints or problems at his work. He worked hard. He has no Criminal History or history of concern or even any stability issues. He was just a Middle aged man who was laid off after a Long History with one company and like Millions of Americans was not able to find New Employment. Millions of Americans have lost their jobs since 2007 and No One has mentioned that they need Health care, that when they are unemployed there is no money to purchase Expensive Cobra, so they go without. And Mr Verome’s life became one such life, he worked at the Convenience Store, the only job he could find and he lived at the Hampton Inn. There were small meals and much stress. He struggled with his back and Disc problems, and with a sore left foot, but he kept working trying to hold his life together. But then the Growth on his chest appeared.
You’ve Seen the Movie — Now It’s Time to ACT!
Thursday, October 22, 2009
It’s the #1 question I’m constantly asked after people see my movie: “OK — so NOW what can I DO?!”
You want something to do? Well, you’ve come to the right place! ‘Cause I got 15 things you and I can do right now to fight back and try to fix this very broken system.
Here they are:
FIVE THINGS WE DEMAND THE PRESIDENT AND CONGRESS DO IMMEDIATELY:
1. Declare a moratorium on all home evictions. Not one more family should be thrown out of their home. The banks must adjust their monthly mortgage payments to be in line with what people’s homes are now truly worth — and what they can afford. Also, it must be stated by law: If you lose your job, you cannot be tossed out of your home.
2. Congress must join the civilized world and expand Medicare For All Americans. A single, nonprofit source must run a universal health care system that covers everyone. Medical bills are now the #1 cause of bankruptcies and evictions in this country. Medicare For All will end this misery. The bill to make this happen is called H.R. 3200. You must call AND write your members of Congress and demand its passage, no compromises allowed.
3. Demand publicly-funded elections and a prohibition on elected officials leaving office and becoming lobbyists. Yes, those very members of Congress who solicit and receive millions of dollars from wealthy interests must vote to remove ALL money from our electoral and legislative process. Tell your members of Congress they must support campaign finance bill H.R.1826.
4. Each of the 50 states must create a state-owned public bank like they have in North Dakota. Then congress MUST reinstate all the strict pre-Reagan regulations on all commercial banks, investment firms, insurance companies — and all the other industries that have been savaged by deregulation: Airlines, the food industry, pharmaceutical companies — you name it. If a company’s primary motive to exist is to make a profit, then it needs a set of stringent rules to live by — and the first rule is “Do no harm.” The second rule: The question must always be asked — “Is this for the common good?” (Click here for some info about the state-owned Bank of North Dakota.)
5. Save this fragile planet and declare that all the energy resources above and beneath the ground are owned collectively by all of us. Just like they do it in Sarah Palin’s socialist Alaska. We only have a few decades of oil left. The public must be the owners and landlords of the natural resources and energy that exists within our borders or we will descend further into corporate anarchy. And when it comes to burning fossil fuels to transport ourselves, we must cease using the internal combustion engine and instruct our auto/transportation companies to rehire our skilled workforce and build mass transit (clean buses, light rail, subways, bullet trains, etc.) and new cars that don’t contribute to climate change. (For more on this, here’s a proposal I wrote in December.) Demand that General Motors’ de facto chairman, Barack Obama, issue a JFK man-on-the-moon-style challenge to turn our country into a nation of trains and buses and subways. For Pete’s sake, people, we were the ones who invented (or perfected) these damn things in the first place!!
FIVE THINGS WE CAN DO TO MAKE CONGRESS AND THE PRESIDENT LISTEN TO US:
1. Each of us must get into the daily habit of taking 5 minutes to make four brief calls: One to the President (202-456-1414), one to your Congressperson (202-224-3121) and one to each of your two Senators (202-224-3121). To find out who represents you, click here. Take just one minute on each of these calls to let them know how you expect them to vote on a particular issue. Let them know you will have no hesitation voting for a primary opponent — or even a candidate from another party — if they don’t do our bidding. Trust me, they will listen. If you have another five minutes, click here to send them each an email. And if you really want to drop an anvil on them, send them a snail mail letter!
2. Take over your local Democratic Party. Remember how much fun you had with all those friends and neighbors working together to get Barack Obama elected? YOU DID THE IMPOSSIBLE. It’s time to re-up! Get everyone back together and go to the monthly meeting of your town or county Democratic Party — and become the majority that runs it! There will not be many in attendance and they will either be happy or in shock that you and the Obama Revolution have entered the room looking like you mean business. President Obama’s agenda will never happen without mass grass roots action — and he won’t feel encouraged to do the right thing if no one has his back, whether it’s to stand with him, or push him in the right direction. When you all become the local Democratic Party, send me a photo of the group and I’ll post it on my website.
3. Recruit someone to run for office who can win in your local elections next year — or, better yet, consider running for office yourself! You don’t have to settle for the incumbent who always expects to win. You can be our next representative! Don’t believe it can happen? Check out these examples of regular citizens who got elected: State Senator Deb Simpson, California State Assemblyman Isadore Hall, Tempe, Arizona City Councilman Corey Woods, Wisconsin State Assemblyman Chris Danou, and Washington State Representative Larry Seaquist. The list goes on and on — and you should be on it!
4. Show up. Picket the local branch of a big bank that took the bailout money. Hold vigils and marches. Consider civil disobedience. Those town hall meetings are open to you, too (and there’s more of us than there are of them!). Make some noise, have some fun, get on the local news. Place “Capitalism Did This” signs on empty foreclosed homes, closed down businesses, crumbling schools and infrastructure. (You can download them from my website.)
5. Start your own media. You. Just you (or you and a couple friends). The mainstream media is owned by corporate America and, with few exceptions, it will never tell the whole truth — so you have to do it! Start a blog! Start a website of real local news (here’s an example: The Michigan Messenger). Tweet your friends and use Facebook to let them know what they need to do politically. The daily papers are dying. If you don’t fill that void, who will?
FIVE THINGS WE SHOULD DO TO PROTECT OURSELVES AND OUR LOVED ONES UNTIL WE GET THROUGH THIS MESS:
2. Get rid of all your credit cards but one — the kind where you have to pay up at the end of the month or you lose your card.
3. Do not invest in the stock market. If you have any extra cash, put it away in a savings account or, if you can, pay down on your mortgage so you can own your home as soon as possible. You can also buy very safe government savings bonds or T-bills. Or just buy your mother some flowers.
4. Unionize your workplace so that you and your coworkers have a say in how your business is run. Here’s how to do it (more info here). Nothing is more American than democracy, and democracy shouldn’t be checked at the door when you enter your workplace. Another way to Americanize your workplace is to turn your business into a worker-owned cooperative. You are not a wage slave. You are a free person, and you giving up eight hours of your life every day to someone else is to be properly compensated and respected.
5. Take care of yourself and your family. Sorry to go all Oprah on you, but she’s right: Find a place of peace in your life and make the choice to be around people who are not full of negativity and cynicism. Look for those who nurture and love. Turn off the TV and the Blackberry and go for a 30-minute walk every day. Eat fruits and vegetables and cut down on anything that has sugar, high fructose corn syrup, white flour or too much sodium (salt) in it (and, as Michael Pollan says, “Eat (real) food, not too much, mostly plants”). Get seven hours of sleep each night and take the time to read a book a month. I know this sounds like I’ve turned into your grandma, but, dammit, take a good hard look at Granny — she’s fit, she’s rested and she knows the names of both of her U.S. Senators without having to Google them. We might do well to listen to her. If we don’t put our own “oxygen mask” on first (as they say on the airplane), we will be of no use to the rest of the nation in enacting any of this action plan!
I’m sure there are many other ideas you can come up with on how we can build this movement. Get creative. Think outside the politics-as-usual box. BE SUBVERSIVE! Think of that local action no one else has tried. Behave as if your life depended on it. Be bold! Try doing something with reckless abandon. It may just liberate you and your community and your nation.
C’mon people — we can do this! I expect nothing less of all of you, my true and trusted fellow travelers!
Let’s start with the obvious: America has not only the worst but the dumbest health care system in the developed world. It’s become a black leprosy eating away at the American experiment — a bureaucracy so insipid and mean and illogical that even our darkest criminal minds wouldn’t be equal to dreaming it up on purpose.
The system doesn’t work for anyone. It cheats patients and leaves them to die, denies insurance to 47 million Americans, forces hospitals to spend billions haggling over claims, and systematically bleeds and harasses doctors with the specter of catastrophic litigation. Even as a mechanism for delivering bonuses to insurance-company fat cats, it’s a miserable failure: Greedy insurance bosses who spent a generation denying preventive care to patients now see their profits sapped by millions of customers who enter the system only when they’re sick with incurably expensive illnesses.
The cost of all of this to society, in illness and death and lost productivity and a soaring federal deficit and plain old anxiety and anger, is incalculable — and that’s the good news. The bad news is our failed health care system won’t get fixed, because it exists entirely within the confines of yet another failed system: the political entity known as the United States of America.
Just as we have a medical system that is not really designed to care for the sick, we have a government that is not equipped to fix actual crises. What our government is good at is something else entirely: effecting the appearance of action, while leaving the actual reform behind in a diabolical labyrinth of ingenious legislative maneuvers.
Over the course of this summer, those two failed systems have collided in a spectacular crossroads moment in American history. We have an urgent national emergency on the one hand, and on the other, a comfortable majority of ostensibly simpatico Democrats who were elected by an angry population, in large part, specifically to reform health care. When they all sat down in Washington to tackle the problem, it amounted to a referendum on whether or not we actually have a functioning government.
It’s a situation that one would have thought would be sobering enough to snap Congress into real action for once. Instead, they did the exact opposite, doubling down on the same-old, same-old and laboring day and night in the halls of the Capitol to deliver us a tour de force of old thinking and legislative trickery, as if that’s what we really wanted. Almost every single one of the main players — from House Speaker Nancy Pelosi to Blue Dog turncoat Max Baucus — found some unforeseeable, unique-to-them way to fuck this thing up. Even Ted Kennedy, for whom successful health care reform was to be the great vindicating achievement of his career, and Barack Obama, whose entire presidency will likely be judged by this bill, managed to come up small when the lights came on.
We might look back on this summer someday and think of it as the moment when our government lost us for good. It was that bad.
Here’s where we are right now: Before Congress recessed in August, four of the five committees working to reform health care had produced draft bills. On the House side, bills were developed by the commerce, ways and means, and labor committees. On the Senate side, a bill was completed by the HELP committee (Health, Education, Labor and Pensions, chaired by Ted Kennedy). The only committee that didn’t finish a bill is the one that’s likely to matter most: the Senate Finance Committee, chaired by the infamous obfuscating dick Max Baucus, a right-leaning Democrat from Montana who has received $2,880,631 in campaign contributions from the health care industry.
The game in health care reform has mostly come down to whether or not the final bill that is hammered out from the work of these five committees will contain a public option — i.e., an option for citizens to buy in to a government-run health care plan. Because the plan wouldn’t have any profit motive — and wouldn’t have to waste money on executive bonuses and corporate marketing — it would automatically cost less than private insurance. Once such a public plan is on the market, it would also drive down prices offered by for-profit insurers — a move essential to offset the added cost of covering millions of uninsured Americans. Without a public option, any effort at health care reform will be as meaningful as a manicure for a gunshot victim. “The public option is the main thing on the table,” says Michael Behan, an aide to Sen. Bernie Sanders of Vermont. “It’s really coming down to that.”
The House versions all contain a public option, as does the HELP committee’s version in the Senate. So whether or not there will be a public option in the end will likely come down to Baucus, one of the biggest whores for insurance-company money in the history of the United States. The early indications are that there is no public option in the Baucus version; the chairman hinted he favors the creation of nonprofit insurance cooperatives, a lame-ass alternative that even a total hack like Sen. Chuck Schumer has called a “fig leaf.”
Even worse, Baucus has set things up so that the final Senate bill will be drawn up by six senators from his committee: a gang of three Republicans (Chuck Grassley of Iowa, Olympia Snowe of Maine, Mike Enzi of Wyoming) and three Democrats (Baucus, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico) known by the weirdly Maoist sobriquet “Group of Six.” The setup senselessly submarines the committee’s Democratic majority, effectively preventing members who advocate a public option, like Jay Rockefeller of West Virginia and Robert Menendez of New Jersey, from seriously influencing the bill. Getting movement on a public option — or any other meaningful reform — will now require the support of one of the three Republicans in the group: Grassley (who has received $2,034,000 from the health sector), Snowe ($756,000) or Enzi ($627,000).
This is what the prospects for real health care reform come down to — whether one of three Republicans from tiny states with no major urban populations decides, out of the goodness of his or her cash-fattened heart, to forsake forever any contributions from the health-insurance industry (and, probably, aid for their re-election efforts from the Republican National Committee).
This, of course, is the hugest of long shots. But just to hedge its bets even further and ensure that no real reforms pass, Congress has made sure to cover itself, sabotaging the bill long before it even got to Baucus’ committee. To do this, they used a five-step system of subtle feints and legislative tricks to gut the measure until there was nothing left.
STEP ONE: AIM LOW
Heading into the health care debate, there was only ever one genuinely dangerous idea out there, and that was a single-payer system. Used by every single developed country outside the United States (with the partial exceptions of Holland and Switzerland, which offer limited and highly regulated private-insurance options), single-payer allows doctors and hospitals to bill and be reimbursed by a single government entity. In America, the system would eliminate private insurance, while allowing doctors to continue operating privately.
In the real world, nothing except a single-payer system makes any sense. There are currently more than 1,300 private insurers in this country, forcing doctors to fill out different forms and follow different reimbursement procedures for each and every one. This drowns medical facilities in idiotic paperwork and jacks up prices: Nearly a third of all health care costs in America are associated with wasteful administration. Fully $350 billion a year could be saved on paperwork alone if the U.S. went to a single-payer system — more than enough to pay for the whole goddamned thing, if anyone had the balls to stand up and say so.
Everyone knows this, including the president. Last spring, when he met with Rep. Lynn Woolsey, the co-chair of the Congressional Progressive Caucus, Obama openly said so. “He said if he were starting from scratch, he would have a single-payer system,” says Woolsey. “But he thought it wasn’t possible, because it would disrupt the health care industry.”
Huh? This isn’t a small point: The president and the Democrats decided not to press for the only plan that makes sense for everyone, in order to preserve an industry that is not only cruel and stupid and dysfunctional, but through its rank inefficiency has necessitated the very reforms now being debated. Even though the Democrats enjoy a political monopoly and could have started from a very strong bargaining position, they chose instead to concede at least half the battle before it even began.
Obama wasn’t the only big Democrat to mysteriously abandon his position on single-payer. House Speaker Nancy Pelosi and Rep. Henry Waxman, the influential chair of the House commerce committee, have both backed away from their longtime support of single-payer. Hell, even Max-freaking-Baucus once conceded the logic of single-payer, saying only that it isn’t feasible politically. “There may come a time when we can push for single-payer,” he said in February. “At this time, it’s not going to get to first base in Congress.”
And helping it not get to first base was … Max Baucus. It was Baucus’ own committee that held the first round-table discussions on reform. In three days of hearings last May, he invited no fewer than 41 people to speak. The list featured all the usual industry hacks, including big insurers like America’s Health Insurance Plans (AHIP), Blue Cross and Aetna. It’s worth noting that several of the organizations invited — including AHIP and Amgen — employ several former Baucus staffers as lobbyists, including two of his ex-chiefs of staff.
Not one of the 41 witnesses, however, was in favor of single-payer — even though eliminating the insurance companies enjoys broad public support. Leading advocates of single-payer, including doctors from the Physicians for a National Health Program, implored Baucus to allow them to testify. When he refused, a group of eight single-payer activists, including three doctors, stood up during the hearings and asked to be included in the discussion. One of the all-time classic moments in the health care reform movement came when the second protester to stand up, Katie Robbins of Health Care Now, declared, “We need single-payer health care!”
To which Baucus, who looked genuinely frightened, replied, “We need more police!”
The eight protesters were led away in handcuffs and spent about seven hours in jail. “It’s funny, the policemen were all telling us their horror stories about health care,” recalls Dr. Margaret Flowers, one of the physicians who was jailed. “One was telling us about his mother who was 62 and lost her job and was uninsured, waiting to get Medicare when she was 65.” The protesters were sentenced to six months’ probation. Baucus later met with them and conceded that not including single-payer advocates in the discussion had been a mistake, although it was “too late” to change that.
Single-payer advocates have had an equally tough time getting a hearing with the president. In March, the White House refused to allow Rep. John Conyers to invite two physicians who support single-payer to the health care summit that Obama was holding to kick off the reform effort. Three months later, a single-payer advocate named David Scheiner, who served as Obama’s physician for 22 years, was mysteriously bumped from a prime-time forum on health care, where he had been invited to ask the president a question.
Many of the health care advisers in Obama’s inner circle, meanwhile, are industry hacks — people like Nancy-Ann DeParle, the president’s health care czar, who has served on the boards of for-profit companies like Medco Health Solutions and Triad Hospitals. DeParle is so unthreatening to the status quo that Karen Ignagni, the insurance industry’s leading lobbyist-gorgon, praised her “extensive experience” and “strong track record.”
Behind closed doors, Obama also moved to cut a deal with the drug industry. “It’s a dirty deal,” says Russell Mokhiber, one of the protesters whom Baucus had arrested. “The administration told them, ‘Single-payer is off the table. In exchange, we want you on board.’” In August, the Pharmaceutical Research and Manufacturers of America announced that the industry would contribute an estimated $150 million to campaign for Obamacare.
Even the Congressional Progressive Caucus, whose 80-plus members have overwhelmingly supported single-payer legislation in the past, decided not to draw a line in the sand. They agreed to back down on single-payer, seemingly with the understanding that Pelosi would push for a strong public option — a sort of miniversion of single-payer, a modest, government-run insurance plan that would serve as a test model for the real thing. But one of the immutable laws of politics in the U.S. Congress is that progressives will always be screwed by their own leaders, as soon as the opportunity presents itself. And with a bill the size and scope of health care, there was plenty of opportunity.
STEP TWO: GUT THE PUBLIC OPTION
Once single-payer was off the table, the Democrats lost their best bargaining chip. Rather than being in a position to use the fear of radical legislation to extract concessions from the right — a position Obama seemingly gave away at the outset, by punting on single-payer — Republicans and conservative Blue Dog Democrats suddenly realized that they had the upper hand. Pelosi and Senate Majority Leader Harry Reid would now give away just about anything to avoid having to walk away without a real health care bill.
The situation was made worse as the flagging economy ate away at Obama’s political capital. Polls showed the percentage of “highly engaged” Democrats plummeting, while the percentage of “highly engaged” Republicans — inspired by idiotic scare stories from Rush Limbaugh and Sarah Palin about socialized medicine and euthanasia — rose rapidly. By late summer, “the depth of Republican support was starting to rival the breadth of Democratic support,” said noted statistician Nate Silver. The more the Republicans and Blue Dogs fidgeted and fucked around, the easier it would be for them to kill the public option. Democrats, who on the morning after Election Day could have passed a single-payer system without opposition, were now in a desperate hurry to make a deal.
The public option is hardly a cure-all: Among other things, it does nothing to reduce the $350 billion a year in unnecessary paperwork and administrative overhead that makes the current system so expensive and maddening. “That’s one of the big issues,” says an aide to a member of the progressive caucus. “None of this addresses the paperwork issue. It might even make it worse.” But the basic idea of the public option is sound enough: create a government health plan that citizens could buy through regulated marketplaces called insurance “exchanges” run at the state level. Simply by removing the profit motive, the government plan would be cheaper than private insurance. “The goal here was to offer the rock-bottom price, the Walmart price, so that people could buy insurance practically at cost,” says one Senate aide.
The logic behind the idea was so unassailable that its opponents often inadvertently found themselves arguing for it. “Assurances that the government plan would play by the rules that private insurers play by are implausible,” groused right-wing douchebag George Will. “Competition from the public option must be unfair, because government does not need to make a profit and has enormous pricing and negotiating powers.” In other words, if you offer a public plan that doesn’t systematically fuck every single person in the country by selling health care at inflated prices and raking in monster profits, private insurers just won’t be able to compete.
Will wasn’t the only prominent opponent of reform openly arguing in favor of the insurance industry’s right to continue doing business inefficiently. Sen. Ben Nelson, who together with Baucus are the Laverne and Shirley of turncoat Democrats, complained that the public option “would win the game.” Senate Minority Leader Mitch McConnell admitted that “private insurance will not be able to compete with a government option.” This is a little like complaining that Keanu Reeves was robbed of an Oscar just because he can’t act.
For a while, the public option looked like it might have a real chance at passing. In the House, both the ways and means committee and the labor committee passed draft bills that contained a genuine public option. But then conservative opponents of the plan, the so-called Blue Dog Democrats, mounted their counterattack. A powerful bloc composed primarily of drawling Southerners in ill-fitting suits, the Blue Dogs — a gang of puffed-up political mulattos hired by the DNC to pass as almost-Republicans in red-state battlegrounds — present themselves as a quasi-religious order, worshipping at the sacred altar of “fiscal responsibility” and “deficit reduction.” On July 9th, in a harmless-sounding letter to Pelosi, 40 Blue Dogs expressed concern that doctors in the public option “must be fairly reimbursed at negotiated rates, and their participation must be voluntary.” Paying doctors “using Medicare’s below-market rates,” they added, “would seriously weaken the financial stability of our local hospitals.”
The letter was an amazing end run around the political problem posed by the public option — i.e., its unassailable status as a more efficient and cheaper health care alternative. The Blue Dogs were demanding that the very thing that makes the public option work — curbing costs to taxpayers by reimbursing doctors at Medicare rates plus five percent — be scrapped. Instead, the Blue Dogs wanted compensation rates for doctors to be jacked up, on the government’s tab. The very Democrats who make a point of boasting about their unwavering commitment to fiscal conservatism were lobbying, in essence, for a big fat piece of government pork for doctors. “Cost should be the number-one concern to the Blue Dogs,” grouses Rep. Woolsey. “That’s why they’re Blue Dogs.”
In the end, the Blue Dogs won. When the House commerce committee passed its bill, the public option no longer paid Medicare-plus-five-percent. Instead, it required the government to negotiate rates with providers, ensuring that costs would be dramatically higher. According to one Democratic aide, the concession would bump the price of the public option by $1,800 a year for the average family of four.
In one fell swoop, the public plan went from being significantly cheaper than private insurance to costing, well, “about the same as what we have now,” as one Senate aide puts it. This was the worst of both worlds, the kind of take-the-fork-in-the-road nonsolution that has been the peculiar specialty of Democrats ever since Bill Clinton invented a new way to smoke weed. The party could now sell voters on the idea that it was offering a “public option” without technically lying, while at the same time reassuring health care providers that the public option it was passing would not imperil the industry’s market share.
Even more revolting, when Pelosi was asked on July 31st if she worried that progressives in the House would yank their support of the bill because of the sellout to conservatives, she literally laughed out loud. “Are the progressives going to take down universal, quality, affordable health care for all Americans?” she said, chuckling heartily to reporters. “I don’t think so.”
The laugh said everything about what the mainstream Democratic Party is all about. It finds the notion that it has to pay anything more than lip service to its professed values funny. “It’s a joke,” complains one Democratic aide. “This is all a game to these people — and they’re good at it.”
The concession to the Blue Dogs comes at a potentially disastrous price: Without a public option that drives down prices, the cost of other health care reforms being considered by Congress will almost certainly skyrocket. The trade-off with conservatives might be understandable, if those other reforms were actually useful. But this is Congress we’re talking about.
STEP THREE: PACK IT WITH LOOPHOLES
Even seasoned congressional aides, who are accustomed to sitting through long and boring committee meetings, have found the debate over health care reform uniquely torturous. Unlike other congressional matters, where there is at least a feeling that the process might at some point be completed, the endless sessions over health care have led many staffers to fear that they will be locked in hearing rooms for the rest of their lives, listening to words like “target” and “mandate” and “doughnut hole” being repeated ad nauseam by weary, gray-faced, saggy-necked legislators — who begin, after weeks of self-inflated posturing, to look like the ugliest people in the universe. “You come out of these hearings,” says Behan, the aide to Sen. Sanders, “and the number of interconnected, moving pieces going in and out of these bills is insane — the case for single-payer health insurance makes itself.”
For those looking to fuck up health care reform — or to load it up with goodies for their rich pals — the tedium actually serves a broader purpose. Given that five different committees are weighing five different and often competing paths to reform, it’s not surprising that all sorts of bizarre crap winds up buried in their bills, stuff no one could possibly have expected to be in there. The most glaring example, passed by Ted Kennedy’s HELP committee, would allow the makers of complex drugs known as “biologics” to keep their formulas from being copied by rivals for 12 years — twice as long as the protection for ordinary pharmaceuticals. The notion that an effort ostensibly aimed at curbing health care costs would grant the pharmaceutical industry lucrative new protections against generic drugs is even weirder when you consider that earlier proposals, including one supported by Obama, would have protected brand-name drugs for only seven years.
Another favor to industry buried in the bills involves the issue of choice. From the outset, Democrats have been careful to make sure that a revamped system would not in any way force citizens to give up their existing health care plans. As Obama told the American Medical Association in June, “If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”
That sounds great, particularly in conjunction with the new set of standards for employer-provided insurance outlined in the House version of reform. Under the bill — known as HR 3200 — employers must provide “essential benefits” to workers or face a stiff penalty. “Essential benefits” includes elements often missing in the fly-by-night plans offered by big employers: drug benefits, outpatient care, hospitalization, mental health, the works. If your employer does not offer acceptable coverage, you then have the right to go into one of the state-run insurance “exchanges,” where you can select from a number of insurance plans, including the public option.
There’s a flip side, though: If your employer offers you acceptable care and you reject it, you are barred from buying insurance in the insurance “exchange.” In other words, you must take the insurance offered to you at work. And that might have made sense if, as decreed in the House version, employers actually had to offer good care. But in the Senate version passed by the HELP committee, there is no real requirement for employers to provide any kind of minimal level of care. On the contrary, employers who currently offer sub-par coverage will have their shitty plans protected by a grandfather clause. Which means …
“If you have coverage you like, you can keep it,” says Sen. Sanders. “But if you have coverage you don’t like, you gotta keep it.”
This grandfather clause has potentially wide-ranging consequences. One of the biggest health care problems we have in this country is the technique used by large employers — Walmart is the most notorious example — of offering dogshit, bare-bones health insurance that forces employees to take on steep co-pays and other massive charges. Low-wage workers currently offered these plans often reject them and join Medicaid, effectively shifting the health care burden for Walmart employees on to the taxpayer. If the HELP committee’s grandfather clause survives to the final bill, those workers who did the sensible thing in rejecting Walmart’s crap employer plan and taking the comparatively awesome insurance offered via Medicaid will now be rebuffed by the state and forced to take the dogshit Walmart offering.
This works out well for the states, who will get to purge all those Walmart workers from their Medicaid rolls. It also works great for Walmart, since any new competitors who appear on the horizon will be forced to offer genuine and more expensive health insurance — giving Walmart a clear competitive advantage. This little “glitch” is the essence of the health care reform effort: It changes things in a way that works for everyone except actual sick people.
Veteran legislators speak of this horrific loophole as if it were an accident — something that just sort of happened, while no one was looking. Sen. Ron Wyden of Oregon was looking at an early version of the bill several months ago, when he suddenly realized that it was going to leave people stuck with their employer insurance. “I woke up one morning and was like, ‘Whoa, people aren’t going to have choices,’” he recalls.
As a means of correcting the problem, Wyden wrote up a thing called the Free Choice Act, which like many of the prematurely sidelined ideas in this health care mess is actually quite sensible. The bill would open up the insurance “exchanges” to all consumers, regardless of who is offered employer-based insurance and who isn’t. But Wyden has little hope of having his proposal included in later versions of the bill. Like Sanders, who hopes to correct the committee’s giveaway to drugmakers, Wyden won’t get a real shot at having an impact until the House and Senate meet to hammer out differences between their final bills. In a legislative sense, the bad ideas are already in the barn, and the solutions are fenced off in the fields, hoping to get in.
STEP FOUR: PROVIDE NO LEADERSHIP
One of the reasons for this chaos was the bizarre decision by the administration to provide absolutely no real oversight of the reform effort. From the start, Obama acted like a man still running for president, not someone already sitting in the White House, armed with 60 seats in the Senate. He spoke in generalities, offering as “guiding principles” the kind of I’m-for-puppies-and-sunshine platitudes we got used to on the campaign trail — investment in prevention and wellness, affordable health care for all, guaranteed choice of doctor. At no time has he come out and said what he wants Congress to do, in concrete terms. Even in June, when congressional leaders desperate for guidance met with chief of staff (and former legislative change-squelcher) Rahm Emanuel, they got no signal at all about what the White House wanted. On the question of a public option, Emanuel was agonizingly noncommittal, reportedly telling Senate Democrats that the president was still “open to alternatives.”
On the same day Emanuel was passing the buck to senators, Obama was telling reporters that it’s “still too early” to have a “strong opinion” on a public option. This was startling news indeed: Eight months after being elected president of the United States is too early to have an opinion on an issue that Obama himself made a central plank of his campaign? The president conceded only that a “public option makes sense.”
This White House makes a serial vacillator like Bill Clinton look like Patton crossing the Rhine. Veterans from the Clinton White House, in fact, jumped on Obama. “The president may have overlearned the lesson of the Clinton health care plan fiasco, which was: Don’t deliver a package to the Hill, let the Hill take ownership,” said Robert Reich, who served as labor secretary under Clinton. There were now so many competing ideas about how to pay for the plan and what kind of mandates to include that even after the five bills are completed, Congress will not be much closer to reform than it was at the beginning. “The president has got to go in there and give it coherence,” Reich concluded.
But Reich’s comment assumes that Obama wants to give the bill coherence. In many ways, the lily-livered method that Obama chose to push health care into being is a crystal-clear example of how the Democratic Party likes to act — showering a real problem with a blizzard of ineffectual decisions and verbose nonsense, then stepping aside at the last minute to reveal the true plan that all along was being forged off-camera in the furnace of moneyed interests and insider inertia. While the White House publicly eschewed any concrete “guiding principles,” the People Who Mattered, it appeared, had already long ago settled on theirs. Those principles seem to have been: no single-payer system, no meaningful public option, no meaningful employer mandates and a very meaningful mandate for individual consumers. In other words, the only major reform with teeth would be the one forcing everyone to buy some form of private insurance, no matter how crappy, or suffer a tax penalty. If the public option is the sine qua non for progressives, then the “individual mandate” is the counterpart must-have requirement for the insurance industry.
“That was their major policy ‘ask,’ and it looks like they’re going to get it,” says Dr. Steffie Woolhandler, a Boston physician who is a prominent single-payer advocate.
The so-called “individual mandate” is currently included in four of the five bills before Congress. The most likely version to survive into the final measure resembles the system in Massachusetts designed by Mormon glambot Mitt Romney, who imposed tax penalties on citizens who did not buy insurance. Several of Romney’s former advisers are involved in the writing of Obamacare, including a key aide to Ted Kennedy who was instrumental in designing the HELP committee legislation. The federal version of the Massachusetts plan would slap the uninsured with a hefty tax penalty — making the HELP committee clause barring people from opting out of their employer-provided plan that much more outrageous.
If things go the way it looks like they will, health care reform will simply force great numbers of new people to buy or keep insurance of a type that has already been proved not to work. “The IRS and the government will force people to buy a defective product,” says Woolhandler. “We know it’s defective because three-quarters of all people who file for bankruptcy because of medical reasons have insurance when they get sick — and they’re bankrupted anyway.”
STEP FIVE: BLOW THE MATH
Health care is a beast — a monster. The House 3200 bill alone is 1,017 pages long and contains countless inscrutable references to other pieces of legislation, meaning that in order to fully comprehend even those thousand pages one really has to read upward of 9,000 or 10,000 pages. There are five different versions of this creature, each with its own nuances and shades, and solving a highly complex mathematical challenge like reconciling the costs of each of the five plans would be beyond even minds who were (a) expert at such things and (b) motivated to get it right. Imagine the same problem in the hands of a bunch of second-rate country lawyers and mall owners, and you about get the idea of what the congressional picture looks like.
For instance: All five of the bills envision a significant expansion of Medicaid. As it stands, the LBJ-era program, which celebrated its 44th birthday on the day before Nancy Pelosi laughed at the progressives, awards benefits according to a jumbled series of state-by-state criteria. Some states, like Vermont, offer Medicaid to citizens whose income is as high as 300 percent of the federal poverty level, while others, like Georgia, only offer Medicaid to those closer to or below the poverty level.
The House plan would expand Medicaid eligibility to automatically include every American whose income is 133 percent of the poverty level or less. For those earning somewhat more — up to 400 percent of the poverty level — federal subsidies would help pay for the cost of a public or private plan purchased via the insurance “exchanges.” That worries state governments, which currently pay for almost half of Medicaid — and which are already seeing their Medicaid rolls swelled by the economic meltdown. A massive surge in new Medicaid members — as many as 11 million Americans under the current proposals, according to the Congressional Budget Office — might literally render many big states insolvent overnight.
Democrats pointed out that under the House plan, the federal government would pay the costs of any “newly eligible” members of Medicaid. But that phrasing, it turns out, was a semantic trick designed to undersell the cost to the states. When Massachusetts imposed a similar mandate under Romney, thousands of people who were already eligible for Medicaid, but had not enrolled, immediately joined the program in order to avoid the tax penalty for being uninsured. So while the House plan would pay for “newly eligible” patients, it won’t cover the “oldly eligible.”
Congress in this instance is behaving like corporations in the Enron age, orphaning hidden costs and complications through clever wording and accounting. Another neat trick involves the federal subsidies for low-income people who make up to 400 percent of the poverty level. The Congressional Budget Office projects that under the House bill, the subsidies will cost upward of $773 billion by 2019. But some aides think that number could end up being much higher. “Without a real public option to drive down costs, the federal support to make sure everyone gets coverage is going to get very expensive very fast,” says Behan, the aide to Sen. Sanders.
Here’s the other thing. By blowing off single-payer and cutting the heart out of the public option, the Obama administration robbed itself of its biggest argument — that health care reform is going to save a lot of money. That has left the Democrats vulnerable to charges that the plan is going to blow a mile-wide hole in the budget, one we’ll be paying debt service on through the year 3000. It also left them scrambling to find other ways to pay for the plan, making it almost inevitable that they would step in political shit with seniors everywhere by trying surreptitiously to whittle down Medicare. As a result, the Democrats have become so oversensitive to charges of fiscal irresponsibility that they’re taking their frustrations out on people who don’t deserve it. Witness Nancy Pelosi’s bizarre freakout over the Congressional Budget Office. When the CBO questioned Obama’s projected cost savings, Pelosi blasted them for “always giving you the worst-case scenario” — which, of course, is exactly what the budget office is supposed to do. When you start asking your accountant to look on the bright side, you know you’re not dealing from a position of strength.
To recap, here’s what ended up happening with health care. First, they gave away single-payer before a single gavel had fallen, apparently as a bargaining chip to the very insurers mostly responsible for creating the crisis in the first place. Then they watered down the public option so as to make it almost meaningless, while simultaneously beefing up the individual mandate, which would force millions of people now uninsured to buy a product that is no longer certain to be either cheaper or more likely to prevent them from going bankrupt. The bill won’t make drugs cheaper, and it might make paperwork for doctors even more unwieldy and complex than it is now. In fact, the various reform measures suck so badly that PhRMA, the notorious mouthpiece for the pharmaceutical industry which last year spent more than $20 million lobbying against health care reform, is now gratefully spending more than seven times that much on a marketing campaign to help the president get what he wants.
So what’s left? Well, the bills do keep alive the so-called employer mandate, requiring companies to provide insurance to their employees. A good idea — except that the Blue Dogs managed to exempt employers with annual payrolls below $500,000, meaning that 87 percent of all businesses will be allowed to opt out of the best and toughest reform measure left. Thanks to Harry Reid, Nancy Pelosi and Barack Obama, we can now be assured that the 19 or 20 employers in America with payrolls above $500,000 who do not already provide insurance will be required to offer good solid health coverage. Hurray!
Or will they? At the end of July, word leaked out that the Senate Finance Committee, in addition to likely spiking the public option, had also decided to ditch the employer mandate. It was hard to be certain, because even Democrats on the committee don’t know what’s going on in the Group of Six selected by Baucus to craft the bill. Things got so bad that some Democrats on the committee — including John Kerry, Chuck Schumer and Robert Menendez — were reduced to holding what amounts to shadow hearings on health care several times a week, while Baucus and his crew conducted their meetings in relative secrecy. The chairman did not even bother to keep his fellow Democrats informed of the bill’s developments, let alone what he has promised Republicans in return for their support of the bill. “The Group of Six has hijacked the process,” says an aide to one of the left-out senators.
This leaves Democrats on the committee in the strange position of seriously considering pulling their support for a bill that will emerge from a panel on which they hold a clear majority. Other Democrats are also weighing an end run around their own leadership, hoping to sneak meaningful reforms back into the process. In the House, Rep. Anthony Weiner of New York refused to support the bill passed by the commerce committee unless he was allowed to attach an amendment that will enable Congress to vote on replacing the entire reform bill with a single-payer plan (Bernie Sanders is working on a similar measure in the Senate). On the labor committee, Rep. Dennis Kucinich of Ohio took a more nuanced tack, offering an amendment that would free up states to switch to a single-payer system of their own.
It’s highly unlikely, though, that the party’s leaders will agree to include such measures when the five competing reform bills are eventually combined. On the House side, “Pelosi has unfettered discretion to combine the bills as she pleases,” observes one Democratic aide. Which leaves us where we are today, as Congress enjoys its vacation, and the various sides have taken to the airwaves in an advertising blitz to make sure the population is saturated with idiotic misconceptions before the bill is actually voted on in the fall.
The much-ballyhooed right-wing scare campaign, with its teabagger holdovers ridiculously disrupting town-hall meetings with their belligerent protests and their stoneheaded memes (the sign raised at a town hall held by Rep. Rick Larson of Washington — keep the guvmint out of my medicare — is destined to become a classic of conservative propaganda), has proved to be almost totally irrelevant to the entire enterprise. Aside from lowering even further the general level of civility (teabaggers urged Sen. Chris Dodd to off himself with painkillers; Rep. Brad Miller had his life threatened), the Limbaugh minions have accomplished nothing at all, except to look like morons for protesting as creeping socialism a reform effort designed specifically to change as little as possible and to preserve at all costs our malfunctioning system of private health care.
All that’s left of health care reform is a collection of piece-of-shit, weakling proposals that are preposterously expensive and contain almost nothing meaningful — and that set of proposals, meanwhile, is being negotiated down even further by the endlessly negating Group of Six. It is a fight to the finish now between Really Bad and Even Worse. And it’s virtually guaranteed to sour the public on reform efforts for years to come.
“They’ll pass some weak, mediocre plan that breaks the bank and even in the best analysis leaves 37 million people uninsured,” says Mokhiber, one of the single-payer activists arrested by Baucus. “It’s going to give universal health care a bad name.”
It’s a joke, the whole thing, a parody of Solomonic governance. By the time all the various bills are combined, health care will be a baby not split in half but in fourths and eighths and fractions of eighths. It’s what happens when a government accustomed to dealing on the level of perception tries to take on a profound emergency that exists in reality. No matter how hard Congress may try, though, it simply is not possible to paper over a crisis this vast.
Then again, some of the blame has to go to all of us. It’s more than a little conspicuous that the same electorate that poured its heart out last year for the Hallmark-card story line of the Obama campaign has not been seen much in this health care debate. The handful of legislators — the Weiners, Kuciniches, Wydens and Sanderses — who are fighting for something real should be doing so with armies at their back. Instead, all the noise is being made on the other side. Not so stupid after all — they, at least, understand that politics is a fight that does not end with the wearing of a T-shirt in November.
As imagined by Dave Lindorff
My Fellow Americans.
I stand before you a chastened president. I made a mistake. Two mistakes really. (Wild applause from Republican side.)
I thought that Congress could do its job and through the deliberative process, produce a health care reform plan that would win broad support across the aisle and among all of you. But I’m afraid that I was wrong. Health care is an enormous industry–maybe the biggest and most powerful industry in the country–and it has far too much power in Congress. Literally thousands of lobbyists, carrying tens of billions of dollars in campaign contributions–have invaded these halls (and my house too, by the way) (relieved laughter) and distorted the process, and in the end have stymied reform. (Expect some hissing.)
Meanwhile, I have realized that the answer has been staring us in the face all along.
And that was my second mistake. I told the American Medical Association that while single-payer medical plans, where the government is the insurer, might work well in other countries, the idea of government running health care was not part of our American tradition. In fact, it is, and has been since 1965, when President Lyndon Johnson signed into law the Medicare program. Medicare is, in fact, a classic single-payer program, and polls and surveys show it is enormously popular with older and disabled Americans. Medicare has relieved our parents and grandparents from the fear that they will not get medical care when they stop working, and it has lifted the enormous burden and worry off of younger Americans over how to pay for the care of their elders, and it has done this with enormous efficiency, all while allowing recipients to choose their own doctors and hospitals. (Applause.)
So we really don’t need to re-invent the wheel. There is no point in members of Congress having to hold endless hearings, and to sit and listen to the pitches of lobbyists from the medical establishment. We can just expand Medicare to cover everyone. (applause)
How much would that cost? Well, we know that 10 percent of the elderly–the oldest and sickest among them–account for 50 percent of total Medicare costs, so that means the other 90 percent only cost some $200 billion a year. Even if we assumed that the rest of the population’s medical bills were as high as those 90 percent, it would mean that expanding Medicare to cover them would cost less than $1 trillion a year, and probably closer to $750 billion. So roughly speaking, we’re talking about adding $750 billion a year to the cost of Medicare.
Now that’s a big number, and I know that some of you–a lot of you–worry about higher taxes. (Republican applause.) But let me assure you, expanding Medicare to cover everyone is going to save you money–virtually everyone. Let’s look at why that is, and why you cannot just look at the federal tax when you consider those savings.
Today, the United States spends nearly 20 percent of GDP on health care. That is more than double what any other country in the world spends on health care. And you know what? We don’t get our money’s worth for all that dough. Canadians, who spend half that percentage of their GDP on health care, and who have what amounts to Medicare for all with their single-payer system (they call it Medicare too), have longer lifespans and better infant mortality statistics than we do. In fact, for that matter Cuba and Mexico have better child health statistics than we do!
By the way, I want to introduce, in the gallery, actress Shirley Jean Douglass, whose father, Tommy Douglass, was the founder of Canada’s Medicare program. (Applause.) We will be consulting closely with experts and administrators of Canada’s Medicare program as we move forward with our own reform. (Applause.)
Now I’ve been accused of lecturing (laughs and applause), and I don’t want to sound like a college professor here, but let me just highlight a few reasons why simply expanding Medicare to cover all of us makes not just moral but economic sense. If we were to make that change, we could immediately eliminate the Medicaid program, which as you know is funded by the states, and costs them (and you) about $400 billion a year, mostly to cover low-income families and individuals. Now that money would not be totally eliminated, because Medicare currently doesn’t cover all health care costs–just 80%. And Medicaid covers the remaining 20% for those elderly and disabled people who cannot afford to pay for Medi-Gap private plans. Even so, eliminating Medicaid for the poor, who would be switched to Medicare, would save at least $300 billion. We could also eliminate the Veterans Administration–which incidentally is an excellent example of true government health care, with publicly owned hospitals and doctors on salary, and it runs very well and very efficiently.
Something those folks at last month’s town meetings who were saying government can’t do anything right should think about. (Wild applause from Democratic side.)
Sorry. I just had to say that. (more applause)
Anyhow, eliminating the VA would save another $100 billion so we’ve already saved more than half the amount that was added to the cost of Medicare in order to cover everyone. (applause)
But there are far more savings.
One of the biggest would be the elimination of about $300 billion that is spent each year by hospitals and doctors to provide care to people with no insurance who end up in hospital emergency rooms. The cost of this “charity care” is factored into higher hospital and physician bills, and ultimately into higher insurance premiums paid by the rest of us. Since all those people would now be covered by Medicare, that expense would vanish.
American companies currently pay about 25 billion a year in workers compensation insurance–money that ultimately comes out of workers’ paychecks. That would no longer be necessary, because people injured on the job would be covered by Medicare. (Smattering of applause mostly from Republican side.)
Car insurance rates would be dramatically lower, because car insurance would no longer have to pay for medical costs following an accident. The same is true for homeowners insurance, which would no longer have to cover the costs of someone being injured on your property. (Applause from Pennsylvania delegation, with among the highest car insurance rates in the nation.)
And of course, the biggest savings of all–about $3,000 per person or $12,000 per family every year–namely the cost of private insurance premiums paid by you and/or your employer, would be gone. Think about that a minute: no more co-pays, no more annual deductibles, no more employee share of insurance premiums for yourself or your family. And for businesses that provide health care coverage, a huge savings that will make them more competitive in the global marketplace, and that will also allow them to pay higher wages to their employees. (Prolonged applause.)
Oh, and there is one other huge, if unquantifiable savings to consider. If everyone has Medicare, the total cost of health care will go down dramatically, because everyone will be getting timely treatment, instead of having to put off exams and early treatment of illness or injury. And no one will suffer the terrible anxiety or worrying about whether they can pay for health care for themselves and their families.
So yes, your Medicare withholding will be perhaps 25 percent higher if we expand Medicare to cover everyone. That tax is currently set at 2.9 percent for you and 2.9 percent for your employer, so it would go up to about 3.7 percent of your paycheck. For someone earning $600 a week, that would represent an increased deduction of about $4.50 a week. For someone earning $1,200 a week, it would be an increased deduction of $9. That is a pretty good deal for not having to pay for insurance coverage any more, wouldn’t you agree? (Applause, plus some boos from largely silent Republican side.)
Now for you folks already receiving Medicare, there have been a lot of scare stories out there, some of them being promoted by some irresponsible people right in this chamber (pause for applause and nervous laughter), suggesting that if we expand health care coverage, it will come off of your benefits. Don’t you believe it! (Applause.)
We live in a democracy, and when a lot of people want something, or benefit from something, they collectively defend that particular thing. In the case of Medicare, if everyone is receiving it, and receiving it in the same manner as everyone else, that creates a huge voting bloc in favor of defending that benefit, so by expanding Medicare to all, we would be creating a powerful political force that will defend Medicare from attack, just as the universality of Social Security has made that program bullet-proof (something my predecessor learned when he tried to promote the idea of privatizing it). (Wild applause from Democratic side.)
So here’s the deal.
I’m admitting it was the wrong move to try to lay it on you poor folks in Congress to come up with some completely new, complicated reform of our existing health care system–if you can even call it that. My good friend and former colleague in this building, Chairman John Conyers, had it right all along: We have a great system–Medicare–that we just need to expand to cover everyone. (Applause.)
So to get it started, I’m going to send Congress a couple of bills. One would immediately shift everyone eligible for Medicaid over to Medicare. I’m calling this the States’ Medical Cost Relief and Medicare Expansion Act. It will not only begin the process of expanding Medicare, but will provide badly needed financial relief to states that are suffering from declining tax revenues and rising health care costs because of the recession. (Applause.)
I will also send Congress a bill that will expand Medicare coverage to all Americans and to legal residents. (Applause, some boos from Republicans.)
I am sure that as financially sound as this change is, there will be opposition from the medical industry, so let me add that this is, for me, a moral imperative, too. For too long, this great country has allowed health care to be a matter of whether or not you had a job with health benefits, or enough money to pay for insurance yourself. That is unacceptable. We are our brothers’ and sisters’ keepers, and just as we believe that every child needs an education, we believe that everyone deserves to have access to quality medical care. (loud applause)
So let me add this: If Congress does not pass these two bills by the end of the current session, in time for the holiday recess in December, I will declare a national emergency because of the recession and the huge rise in the uninsured that it has caused, and will issue executive orders implementing both these measures. It’s not the way I would prefer to see things done, but if Congress cannot act, I promise you and the American people, I will. (Applause and boos.)
Let me also say that this program is a priority for me and for all Americans, and anyone–Republican or Democrat–who gets in the way can expect to hear from me, and from the American people, in this coming election year. (Applause.)
Thank you and good night. (applause)
Living in Massachusetts should, by all indicators, mean having access to good health care. Following the landmark passage of a health insurance mandate in 2006, the state today enjoys the nation’s lowest percentage of uninsured citizens. Major cities like Boston have the nation’s highest numbers of doctors per capita and anchor some of the world’s largest and most prestigious medical centers. And Massachusetts isn’t stingy—it spends more on health care per person than any other state. Yet, as a remarkable NPR documentary reported last year, patients calling Massachusetts General Hospital—ranked the fifth best in the nation by U.S. News and World Report—were informed that Harvard’s massive academic hospital was no longer accepting new patients needing primary care. And that problem isn’t limited to Massachusetts General—it’s occurring throughout the state. Despite near-universal insurance, oodles of doctors, reams of cash, and no dearth of bright minds, the average person in Massachusetts can’t find a new primary care doctor.
The nation soon may face the same fate. To have any hope of meaningful national health reform, therefore, we must address the perverse financial incentives that created and continue to inflame this problem.
The root of the shortage can be traced to 1985, when a Harvard economist named William Hsiao developed a scale to measure the relative value of every single one of the thousands of services provided by doctors, a job later compared to measuring “the exact amount of anger in the world.” For example, Hsiao’s team deemed that a hysterectomy required 3.8 times more mental effort and 4.47 times more technical skill than a psychotherapy session. In 1992, Medicare formally adopted Hsiao’s concept; private insurers followed suit. Today, this relative value-based system sets the prices—and therefore drives the priorities of American medicine.
Here’s how it works. Doctors do a job—like placing a coronary artery stent, reading an EKG, or spending an hour examining and diagnosing a patient with a complex problem like insomnia—and earn something called “relative value units.” In 2009, according to Medicare, the stent guy scores about 24 units for his relatively quick procedure, the EKG person gets 0.5 units for the 10 seconds his job requires, and the poor internist gets only 2.5 units for his hour of time. Figuring a doctor’s total take per task is straightforward: Medicare adds up a doctor’s total RVUs, multiplies the total by a fixed amount (roughly $40 right now), and writes the check.
It’s clear that Medicare and all major insurers place far more relative value on fancy procedures like stents, EKGs, skin biopsies, CT scans, and bowel clean-outs than they do on actual face-to-face time with patients. Procedures, they have decreed, require more mental effort and skill than seeing actual people. The implications are obvious. Just visit any hospital: The dermatology, radiology, and cardiology centers that depend on high-volume, relatively quick procedures have gleaming new facilities, while the primary care and psychiatry clinics languish, since they earn their keep from poorly compensated face-to-face time with patients. And, obviously, specialists make more money than primary care doctors. (Even trainees grasp this; recently, only a single graduating internist out of a class of 50 residents at Massachusetts General Hospital planned to become a primary care doctor.)
Fundamentally, the entire payment model of American health care drives medical centers, doctors, and hospital managers to push for more fancy procedures at the expense of primary care doctors. How’d we get here? Since 1992, Medicare has depended almost entirely on the American Medical Association for guidance on how relative values should be set. In a devastating critique published in the Annals of Internal Medicine, scholars from the Urban Institute and the University of California-San Francisco explained that Medicare uncritically accepted 95 percent of the AMA’s recommendations, which are formulated by the group’s Relative Value Scale Update Committee, or RUC.
Of the committee’s 29 members, 23 are appointed from subspecialties like cardiology and dermatology. Just three represent primary care, even though half of all Medicare dollars are spent on face-to-face encounters. Their meetings are closed to uninvited observers. Unsurprisingly, over time, the relative values of various procedures far outpaced face-to-face “evaluation and management.” In 2000, for example, the RUC recommended relative value increases in 469 specialty procedure codes but made no change in codes related to evaluation and management—which are used by primary care doctors for outpatient visits for physicals, back pain, headaches, and so on.
This price-fixing process explains why people can’t find primary care doctors in Massachusetts. By law, Medicare’s costs are capped so what one doctor gains, another loses. (Medicare has long “rationed” care in this manner.) To meet budget targets, Medicare doesn’t alter the relative valuations of different medical services; instead, it simply cuts the multiplier (say, from $40 to $38 per RVU), which just worsens the disparity between specialists and primary care doctors.
Over time, the big-money specialists dominating the AMA have demanded more and more “relative value” for their procedures. Medicare has rolled over and complied, which has drained revenue from the little-money workhorses—primary care doctors. More than any peculiarity of American medicine, these procedure-mad incentives have corrupted our health care system.
The funny thing is, paying more for medical care that’s more valuable does makes sense. That’s how capitalism should work. Unfortunately, ever since William Hsiao created the system in 1985, the collusive market valuation of medical services considered only the doctor (paying for his or her mental effort and stress, for example). The system completely fails to consider the value to the person actually getting the service. If we did, for example, angioplasties for stable chest pain would never be worth so much more than outpatient visits to lower cholesterol and blood pressure, which are just as effective.
Who speaks for patients? The 36-employee Medicare Payment Advisory Committee serves as Congress’ adviser on Medicare policy but lacks the authority and funding to counter the AMA’s lobbying. For years, MedPAC has sensibly argued that Americans shouldn’t outsource medical pricing to a private interest group. Because properly valuing medical services is a public good, we should invest tax dollars in comparative effectiveness studies and a stronger public agency to fight for patients.
That terrifies powerful special interest groups like physician specialty societies and drug companies. In the mid-1990s, the medical device maker Medtronic sued to block a sound federal report showing spinal fusions didn’t help back pain, and Republicans gutted the responsible agency. The Medicare-approved relative value for the pointless surgery remained largely unchanged and the gravy train chugged along. When Barack Obama recently proposed expanding MedPAC and reducing some of the AMA’s influence, the interest groups again fought back ferociously to defend the status quo—and christened MedPAC a “death panel.”
And while nobody’s been looking, they pulled the plug on primary care doctors.
I recently watched a chunk of so-called cable “news”. A tiff between Sarah Palin and David Letterman monopolized all three hours.
Meanwhile, not one word was uttered about a Kuwaiti man named Fayiz al-Kandari who has been “detained” (read: tortured) in three different prisons for nearly 8 years.
I’ve had the good fortune to talk with Al-Kandari’s lawyer. I’d link to his op-eds, but I can’t, because, despite commitments from major newspapers, they were never published. I’ll provide substantial quotes from him, instead.
With that, allow me to introduce you to Barry Wingard and Fayiz al-Kandari:
Major Barry D. Wingard, Jr.: Judge Advocate General (JAG), Public Defender (Pittsburgh, Pennsylvania), Office of General Counsel, Guantanamo Bay, Defense Attorney, and so much more. His stellar resume gleams with awards and decorations as a result of 25 years of service in the U.S. military. He has prosecuted more than 100 cases in Baghdad, and has also investigated crimes in Bosnia.
[H]e signed on to handle detainee cases expecting to encounter the “worst of the worst.” … [B]ut the justice system at Guantanamo, not the detainees, represented that worst. [...] [He] expected to work within a military justice system similar to the ones in which [he'd] spent [his] career. Instead, [he] said, [he] found a chaotic environment in which cases were tainted by questionable interrogation techniques and evidence was scattered, missing, of questionable origin or simply unavailable. For the … experienced JAG officer, working in a system that [he] considered to be so lacking in proper legal procedures was frustrating and disturbing. [He is] among a handful of military attorneys who have chosen to risk their careers by publicly voicing criticisms of the Military Commissions, which face an uncertain future.
But he can’t get to square one with American newspapers. Moving on… Introducing:
Fayiz al-Kandari: Kuwaiti detainee at Gitmo. He studied law in the United Arab Emirates and is from a well-to-do family, has a long history of doing charity work, and was in the wrong place at the wrong time. He has consistently maintained his innocence (he was on a charity mission and was sold into custody, not nabbed on the battlefield).
Now. Why am I (as opposed to say, the New York Times) the one putting this story out? Allow me to quote Major Wingard:
“I’ve given up on American media.”
While he does just fine by Al Jazeera and AFP overseas, here in the good ol’ U. S. of A., he can’t, for lack of better words, get arrested. The media is much too busy with Palin, Miss California, Palin, and Jon & Kate Plus 8. And Palin. Looks like Brian Williams and Newsweek are getting scooped by Middle Easterners and the French. Et moi.
Now back to our story, already in progress:
Al-Kandari went to Afghanistan in 2001 to provide humanitarian aid. But oops, his bounty hunters made some quick cash at his expense:
The evidence that has kept Fayiz locked up without charges for more than seven years is razor thin and questionable at best. Despite being subjected to harsh treatment and enhanced interrogation techniques, Fayiz’s story has remained consistent.
Let’s recap: Some guy made a couple of afghanis by selling Fayiz to our guys so that the thug-infested Bush administration could justify their fraudulent little war and all its torture-y perks.
And what did Fayiz get? This:
While in U.S. custody in Kabul in December 2001, Al-Kandari was shackled in various stress positions for as long as 36 hours at a time. He was beaten with a chain and water hose. Photographs documenting his condition have not been released. In early 2002, Al-Kandari was transferred to Bagram and held in a roofed tent with no sides where overnight temperatures typically reached below freezing. Photographs again documented his condition, but they have never been released. […] He was transferred to Kandahar in early 2002, … [where] his entire body was shaved (except for a cross on his chest, which was later shaved off) and he was initially kept awake in solitary confinement for five straight days. The abuse continued and resulted in broken ribs and severe bruising documented by medical exams performed months later.
Before being placed on the plane out of Kandahar, his sound-proof headgear was lifted and a female voice whispered, “You are going to hell in GTMO.” At the time, he was also drugged, sandbagged, and placed into a head harness for the 24 hour trip.
At Guantanamo, he was again shackled into stress positions for extended periods of time. He was also urinated on and subjected to sleep deprivation, strobe lights, ear piercing music, cell extractions, and extreme heat and cold conditions in his cell via temperature controls. All told, Al-Kandari has been interrogated approximately 400 times and abused throughout the time he was in U.S. custody.
Wait, sidebar: I smell a reason for releasing those pesky torture photos everyone’s talking about… evidence. Sidebar over.
So… all that torture must have worked, right? I mean, who could withstand that kind of abuse and not spill what’s left of their guts, because, you know, “some” say torture works and– What’s that? Sorry, something’s coming through my imaginary earpiece:
A Department of Defense legal review of Al-Kandari’s case found the evidence against him “is made up almost entirely of hearsay evidence recorded by unidentified individuals with no first hand knowledge of the events they describe.”
In short, the U.S. learned nothing of value from its abusive treatment of Al-Kandari and in all likelihood exculpatory materials confirming Al-Kandari’s whereabouts and accounts of abuse will be classified and withheld from public view.
So what options are available to Fayiz and those like him? Not many. It all boils down to those infamous military commissions, Wingard’s skills, and a judge who will believe Fayiz’s testimony, because with the word “classified” popping up everywhere, that’s all detainees like him have.
Sidebar #2: Per Barry Wingard, “the military is not behind the commissions.” Sidebar #2 over.
However, Major Wingard did share one silver lining with me: He could get a sympathetic judge. Maybe. If he’s lucky. But—and there’s always a pesky but– delays and more delays are kicking that silver-lined opportunity down the road, and Fayiz is still in prison.
But at least he has one hell of a caring, persistent, ethical lawyer.
Vice-President Cheney insists that enhanced interrogations were only used on “hardened terrorists” after other efforts failed, that such efforts prevented the deaths of thousands, and that the U.S. never lost its moral bearings in its treatment of detainees. Al-Kandari is living proof he is wrong on all counts.
Sadly, being right just isn’t enough.
To your knowledge, did any private contractors interrogate Fayiz? Who exactly did?
Fayiz was interrogated over four hundred times, sometimes by military, civilians, and combinations thereof. What is interesting is that hundreds of photos were taken of him along with medical records in various stages of being broken physically. Unfortunately all the information above has been classified as top secret for “your protection,” it has nothing to do with the exculpatory nature of the evidence.
I’d love some quotes from Fayiz. Can you give me any?
“Everybody has convinced themselves that GTMO is over and we can now move on to other, more pleasant topics, well I’m still here with not a single thing to show for it. This really would be much less frustrating if only I had done something to deserve the past seven and a half years being taken.”
How is he being treated now?
Current treatment [Major Wingard provided the link; I am providing the excerpts]:
Guantanamo suicide exposes detainees’ despair under Obama
(AFP) 5 June 2009 WASHINGTON – A Guantanamo prison detainee’s suicide earlier this week highlights the mental state of those locked up for seven years without trial and aggravated by disillusionment born from President Barack Obama, defense lawyers say. ‘Suicide is a humane response to intolerable conditions. Especially where there is no end in sight and that’s the case here,’ David Remes, a lawyer for 15 Yemeni detainees, told AFP. After the new US president announced he would close the detention camp at the remote US naval base in southeast Cuba by 2010, ‘everybody expected Obama to move more swiftly’ to release inmates or at least improve conditions, Remes said. […] Most Guantanamo detainees are still being held in isolation, in cells crudely furnished with a bunk, sometimes with no windows, under the perpetual glare of neon lights. The new US administration, which has promised to abide by the Geneva Conventions on prisoners, has provided some improvements in the detainees’ lives, however.[…] Most of the detainees, however, despite Obama’s overtures on closing the facility, remain depressed and desperate, said Remes. Only two out of the remaining 240 detainees have been able to leave the camp since January. ‘These isolated improvements cannot offset the misery of solitary confinement, especially the conditions of solitary confinement that these men must endure,’ maintained Remes. ‘And they can’t offset the continued harassment by the guards, and the brutality of the guards.’ A majority of the detainees ‘are more discouraged because Obama seemed to bring new hope and that hope proved to be false, a false hope,’ he added. [Human Rights Watch’s Stacy] Sullivan said many of the detainees are suffering severe psychological problems. [...] ‘Obama ‘tried to improve the conditions, based on years of reporting of journalists, human rights groups … He made a good effort to respond to this criticism. It’s just not enough.’ Major Barry Wingard, a military lawyer representing Kuwaiti detainee Fayiz Al Kandari, reported that his client said he knew that under former US president George W. Bush ‘we would never get justice, we knew we would never get out.’ According to Al Kandari, with Obama’s election, the prison population ‘held up the possibility that things were going to get better,’ Wingard said, adding that ‘they began to think like (they were) a human being again,’ Wingard said. Continued harassment by guards, notably physically tough ‘cell extractions,’ are still taking their toll, said Wingard. Al Kandari reported to his lawyer that ‘guys go and bring you out of your cell for any small infraction, such as a towel being hung in the wrong location.’ Such action has been increasing, said Wingard. When detainees are extracted, ‘someone accidentally steps on your hand, rips your head at the pressure points … and you might be pepper sprayed in your face.’ Uncertainty itself, about not knowing when freedom will come, ‘is a form of abuse that does not heal like a bruise or broken bone,’ said Wingard. ‘But still, they’re still waiting, still no justice. Four months delay here, six months delay there, another eight months…’
Please tell me again how often you get to see Fayiz? Any idea if other detainees have a similar amount of access to their attorneys?
I see Fayiz every month for multiple visits. I have established a level of trust with him that is difficult to do considering I wear the same uniform as his jailers. Overall, 70% of the detainees outright reject their lawyers, 30% are lukewarm etc… Remember there are military/criminal lawyers and civilian/civil (Habeas lawyers).
As a lawyer, you have to be pretty objective in order to come up with arguments, etc. But how do you feel about all this, and how does that affect you as you work?
Objectivity: The government refuses to speak in specifics to prevent specific questions being asked. Currently I am heartened that the government acknowledges that it lacks the evidence to gain a conviction in a “regular court” (Federal District Court) but I am equally concerned that they are designing a system to assist the Prosecution. There are many ways to game a system based on precedence that is starting on day one when it begins such as rules of evidence, classification of exculpatory evidence, resources for witnesses, etc..
In your bio, you call the horrific treatment Fayiz got, “enhanced interrogation techniques”… Why don’t you refer to them as “torture”?
Torture is a legal term decided in a court of law and not among talking heads on cable news shows. If breaking a mans ribs with fists or beating him with a chain is “enhanced interrogation” then so be it.
Are you optimistic that we can get back to upholding the ideals of justice as it should be? And that this kind of treatment, bounty hunting, etc. has ended/will end under Obama?
Obama: Obama has perhaps broken the spirit of the detainees in a way the former administration could never.
Fayiz: “when they used to short shackle me to the floor for 36 hours at a time, I knew not to eat or drink the day before and I kept my eyes shut because just seeing them come in the middle of the night with the dogs in a strobe lit room was terrifying to me. I learned to cope and could deal with it. When the new administration offered hope, that was something placed inside my soul, something that cannot be expelled or prepared for.”
How can the U.S. justify holding all these people for years without trials? Comment?
The US cannot justify holding the detainees without some form of an Article 5 hearing which should have been done in 2002 or 2003.
Is there anything you or anyone, including Fayiz, can do to lessen the resentment, fear, etc. that’s so prevalent?
As long as the US government continues to use justice like a magician uses a rabbit in his show, then no, I have little faith. Currently the government is preparing to create a system “not designed to help me” Fayiz says.
To date, the government has not produced a single tangible piece of evidence against Fayiz, just like Boumedian who was released last week after 7 ½ years. Amazingly Fayiz wants to be released and go home and start a business and a family.
They have not been able to break Fayiz in over 400 interrogations which scares the shit out of them and obviously proves “he is super Al Queda” according to his Annual Review Board (ARB) allegations.
He also attempts to help others read and exercises in his cell. Honestly he could care less about the US.
Fayiz: “If the US believed they really had the worst of the worst, they had an opportunity to convert every detainee with education and understanding. Unfortunately, the US chose the wrong course and has released 2/3 (550) of everyone ever held here. Education can counter ignorance from both countries, the people in the US who hate Muslims are the same as the Muslims who hate the US. Ignorance is what feeds intolerance and vice versa.”
Here’s one more question, but it is not directed at either Barry Wingard or Fayiz al-Kandari: Why are these atrocities allowed to continue in the name of the United States of America?
After November 4, 2008, I thought I’d have the answer to that one. I was mistaken.
Major Wingard and I agree that both Democrats and Republicans share some blame here. Many Democrats should have spoken up, and they didn’t. To this day, only a handful have. It boggles the mind.
So, kudos to any in the military (especially lawyers), Democrats and Republicans who opposed the former administration. To emphasize that point, allow me to quote Major Wingard, from a recent e-mail:
Soldiers are taught early on that you will abide by the Geneva Convention; so it comes as no surprise to me that the military as a whole and more particularly officer’s, especially senior ones oppose mistreating captives. The idea of torturing detainees is beyond belief. Remember, the act of surrender involves a leap of faith that captors will not treat those captured in a barbaric way ever, period. As military officers, we strongly encourage surrender without incidence in every circumstance.
The DOJ are the masterminds who came with idea of beating people results in good information. The DOJ also designed the Commissions process; it really should be called the “Department of Justice Commissions” and premised on their “torture memo” principals. I guess if you believe beating individual’s results in good intelligence, then it only follows that hearsay evidence is “presumptively” reliable and “Santa is making a list and checking it twice.” Things play out a little differently when wearing body armor in 130 degree war zones then they appear in air-conditioned office buildings in DC.
Note: I am extremely proud of our military, our kids are some of the bravest and most selfless citizens I have ever me. You can point to specific instances where junior officers and soldiers lost their nerve and succumbed, but divided by the number of daily interactions, abuse was extremely rare and minimal.
I am especially proud of the senior military JAG attorneys who held tightly to their independent judgment and refused to buckle under the former administration and their desire for quick convictions. America maintains the most chivalrous officer corps in the world.
The US military kicks serious ass when used as it is designed: We break things and kill people, period.
I do love the military, and would never disrespect it. It’s just a shame we are so damn obedient to the smooth faced lawyers and politicians.
I think to draw lines like democrat/liberal good and republican/bad allows Fayiz to be imprisoned while “the teams change sides.” Call it what you will, blame whomever you want to blame, make yourself feel as good as you can, but let’s end this in whatever combination of peoples and policies we can. I would say invite everybody to the show and alienate as few as possible, at least initially.
Major Wingard, I salute you.
This is one of many familiar stories that you’ve undoubtedly heard before. Let’s get this one some attention. Having “private” sympathy for someone in this horrific situation isn’t enough. Please take the time you’d spend being frustrated or feeling compassion for Fayiz, and invest it in a phone call or e-mail to your local paper and/or Congressperson. Make a difference. Please.
Naomi Wolf: John Yoo’s Legal Groundwork for the Possible Subversion of Liberty that US Citizens Narrowly Averted
If history gets this recent era right, future textbooks will have to show that the US narrowly averted a carefully planned but thorough and unmistakable conspiracy to subvert the rule of law and the process of democracy from 2001-2008. For three years, since writing End of America, I have been arguing inferentially that the Bush team sought to possibly subvert liberty. Fortunately, this appalling and conceivably irrevocable subversion of the tenets of freedom was narrowly averted by citizens at every level — from the grassroots to the courts — resisting in time. But the release this week by the Justice Department of the “secret memos” sought valiantly by the ACLU confirms that Bush’s legal architects were building up the framework for something even scarier than our most anguished projections.
You can see the documents themselves online — but, as usual, there is a gap between the cautious journalistic interpretation of the event and the dense legalese in which they are written, and no one yet has really explained to citizens who are not attorneys what these memos claimed to give Bush the right to do. This is my initial reading of these documents:
Most dramatically, one memo asserts that Bush can deploy the military within the United States — all of the military if he so wishes — overriding Posse Comitatus, which has kept us safe from military policing for over a century. As many heard me warn in October and November of last year, when the first troops were sent to US streets, history shows that once the military is deployed domestically to “keep order” in a civil society, it is over. This memo is especially galling, since last fall’s red alert from us was met with alarm by citizens but by ridicule by mainstream media outlets. Turns out we were right. This `deployment’ memo proves that Bush indeed, as we feared, wanted the power to deploy military for domestic policing purposes, a mission that Northcom spokesmen denied — apparently falsely — when a few critics from non-mainstream platforms raised the alarm last November about the deployment of the First Brigade from Iraq to the US. This memo shows that Bush sought the power to deploy any number of U.S. military into the U.S. itself for any reason he chose; direct them to rip through your home without a warrant, even if you have not been charged with anything; seize material and documents; and even gave Bush the power to use deadly force against you — yes, you, innocent US citizen — “in self-defense.” In your homes and streets — not on a faraway battlefield. Major David Antoon confirmed that this power — to send US military to control, arrest and even shoot US civilians in self-defense — was in Bush’s hands last fall when I asked Antoon about it. Turns out this memo shows Bush indeed wanted to have that power.
Another memo would give the power to Bush — at his discretion — to close down or censor newspapers, radio and the Internet – override the First Amendment in the interest of “national security.” So if he had deployed, say, ten brigades — 37,000 warriors — in key cities (he deployed three before the election and 20,000 are due to be deployed domestically by 2012 unless we stop it), you would not be able to hear about it through the news media if he invoked this power to suspend free speech. And if you protested — if you dared — well, his actions would have been — thanks to John Yoo and others, who will go down in history along with the criminal Nuremberg lawyers as one of Satan’s willing attorneys — perfectly legal.
Yet another memo gives Bush not only the right to call any US citizen an “enemy combatant” and hold him or her indefinitely – a danger we knew about, and one that we have tried hard to alert citizens to, a warning that has seemingly penetrated collective consciousness. The newly released memo demonstrates that was the very surface of the powers over US citizens Bush claimed. For three years when I have cautioned citizens about this power Bush invoked to seize US citizens as “enemy combatants” I reassured them that he did not yet have the power to torture US citizens, “only” drive them mad through prolonged isolation in a navy brig. Well, this memo asserts Bush’s right to do whatever he wants to innocent US citizens in this kind of custody, and rejects the notion that Congress would have any role in how US citizens are held or treated — say, by the hypothetically deployed military – on US soil. It seems also to claim the right to hold innocent US citizens in domestic military custody while Bush has the right to do anything he wants to them. Anything he wants. Remember this is an administration in which Bush, Rice, Rumsfeld and Cheney have now been proven by Jameel Jaffer’s revelations in Administration of Torture to have known about and okay’d not just waterboarding as a policy but ok’d the discretion for interrogators to use tactics such as electrodes attached to genitals, sexual assault, threats against family members, suffocation, the beating of prisoners’ legs to “pulp,” and in some cases the covering up of their murders. This memo gives Bush the authority to do those things if he wants to innocent US citizens.
Still another memo gives Bush the right to ignore any international treaties — to take over any country, say, or render and citizen anywhere, and do whatever he wants to the citizens of any country against any law, without consent of Congress.
The Washington Post called these memos “legal errors.” We need to stare them in the face and understand them: they are evidence that the groundwork was laid out that gave the president the legal power effectively subvert the Republic. We need to understand the full darkness of what we narrowly escaped — for now, our work is hardly begun. We need to build these lessons into our history and to use the terror they represent to dismantle the last of Bush’s evil legacy — a legacy that could have been activated by any US president in the future, including Obama or McCain — and see these memos for what they are: the revealed architecture of an intended edifice of what amounts to treason again our republic and against all of us, regardless of belief, station of life, or political party.
Fears are growing for the fate of thousands of young girls in rural Mauritania, where campaigners say the cruel practice of force-feeding young girls for marriage is making a significant comeback since a military junta took over the West African country.
Aminetou Mint Ely, a women‘s rights campaigner, said girls as young as five were still being subjected to the tradition of leblouh every year. The practice sees them tortured into swallowing gargantuan amounts of food and liquid – and consuming their vomit if they reject it.
“In Mauritania, a woman’s size indicates the amount of space she occupies in her husband’s heart,” said Mint Ely, head of the Association of Women Heads of Households. ”We have gone backwards. We had a Ministry of Women’s Affairs. We had achieved a parliamentary quota of 20% of seats. We had female diplomats and governors. The military have set us back by decades, sending us back to our traditional roles. We no longer even have a ministry to talk to.” Mauritania has suffered a series of coups since independence from France in 1960. The latest, in August last year, saw General Mohamed Ould Abdelaziz seize power after the elected president tried to sack him.
A children’s rights lawyer, Fatimata M’baye, echoed Ely’s pessimism. “I have never managed to bring a case in defence of a force-fed child. The politicians are scared of questioning their own traditions. Rural marriages usually take place under customary law or are overseen by a marabou (a Muslim preacher). No state official gets involved, so there is no arbiter to check on the age of the bride.” Yet, she said, Mauritania had signed both international and African treaties protecting the rights of the child.
Leblouh is intimately linked to early marriage and often involves a girl of five, seven or nine being obliged to eat excessively to achieve female roundness and corpulence, so that she can be married off as young as possible. Girls from rural families are taken for leblouh at special “fattening farms” where older women, or the children’s aunts or grandmothers, will administer pounded millet, camel’s milk and water in quantities that make them ill. A typical daily diet for a six-year-old will include two kilos of pounded millet, mixed with two cups of butter, as well as 20 litres of camel’s milk. “The fattening is done during the school holidays or in the rainy season when milk is plentiful,” said M’baye. “The girl is sent away from home without understanding why. She suffers but is told that being fat will bring her happiness. Matrons use sticks which they roll on the girl’s thighs, to break down tissue and hasten the process.”
Other leblouh practices include a subtle form of torture – zayar – using two sticks inserted each side of a toe. When a child refuses to drink or eat, the matron squeezes the sticks together, causing great pain. A successful fattening process will see a 12-year-old weigh 80kg. “If she vomits she must drink it. By the age of 15 she will look 30,” said M’baye.
Historians say the practice dates back to pre-colonial times when all Mauritania’s white Moor Arabs were nomads. The richer the man, the less his wife would do – the preference being for her to sit still all day in her tent while her black slaves saw to household chores. Ancient Berber quatrains laud tebtath (stretchmarks) as jewels. Even today lekhwassar (fat around the waist) is given lyrical pride of place and girls sent for fattening gain the stature of mbelha. They are taught to sit in the lotus position, speak softly, use utensils and to emulate the exemplary lives of the Prophet Muhammad’s wives. Fattening of girls is practised beyond Mauritania, in northern Mali and rural Niger – areas conquered, along with half of present-day Spain and Portugal, by the Almoravid dynasty in the 11th century. The practice of fattening also continues in Nigeria’s Calabar state and north Cameroon.
The resurgence of the practice in rural Mauritania is a depressing setback for campaigners after previous education and awareness campaigns were apparently having a tangible effect. “The challenge we face is that these girls live in rural areas and do not have access to information,” said Ely. “Until the military coup last year, we had made strides. Ten years ago we ran information campaigns about the dangers of cardiovascular disease and diabetes. The government even commissioned ballads condemning fattening.” Many middle-class Mauritanians, among a population estimated at three million, claim the practice of force-feeding no longer exists.
Political scientist Mohamed el-Mounir, 38, claimed western influence had wiped out the allure of feminine fat. “Fattening is something from the 1950s. These days girls watch fashion shows on television. Their role models are American actresses or Lebanese singers in sexy dresses. Girls do sport. Yes, Mauritanian men like slightly round women. But there is no way we want them obese.”
Health and development consultant Mounina Mint Abdellah, 51, said she was force-fed as a child by her mother’s family. “Things have changed tremendously. When I left school in 1980 it would have been unthinkable for me to go abroad to study. But now, 30 years later, my daughter is doing her master’s degree in France. We owe a great deal to the fact that all girls are now expected to go to school. These changes have had a tremendous impact on ancestral practices. Fattening just seems out of date to a large part of Mauritanian society.”
But Ely and M’baye insist the fat “ideal” is back. Ely cites the life-threatening weight-gain practices of some grown women. “To remain fat, as adults, they take animal hormones or buy prescription drugs with appetite-enhancing side-effects. A woman died in hospital in Nouakchott last week. I’m afraid this problem is still very much with us.”
• Additional reporting by Manon Rivière in Nouakchott