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Subject: Reich: Medicare Is the Solution, Not the Problem, Peter Yarrow: Tim DeChristopher's courageous bid to save our world
Medicare Is the Solution, Not the Problem
By Robert Reich,
Robert Reich's Blog: 23 July 11
Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare.
But Medicare isn't the nation's budgetary problems. It's the solution. The real problem is the soaring costs of health care that lie beneath Medicare. They're costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.
Medicare offers a means of reducing these costs - if
Let me explain.
Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That's almost two and a half times the average of other advanced nations.
Yet the typical American lives 77.9 years - less than the average 79.4 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.
Medical costs are soaring because our health-care system is totally screwed up. Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.
You have lower back pain? Almost 95% of such cases are best relieved through physical therapy. But doctors and hospitals routinely do expensive MRI's, and then refer patients to orthopedic surgeons who often do even more costly surgery. Why? There's not much money in physical therapy.
Your diabetes, asthma, or heart condition is acting up? If you go to the hospital, 20 percent of the time you're back there within a month. You wouldn't be nearly as likely to return if a nurse visited you at home to make sure you were taking your medications. This is common practice in other advanced countries. So why don't nurses do home visits to Americans with acute conditions? Hospitals aren't paid for it.
Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the
A major occupational category at most hospitals is "billing clerk." A third of nursing hours are devoted to documenting what's happened so insurers have proof.
Trying to slow the rise in Medicare costs doesn't deal with any of this. It will just limit the amounts seniors can spend, which means less care. As a practical matter it means more political battles, as seniors - whose clout will grow as boomers are added to the ranks - demand the limits be increased. (If you thought the demagoguery over "death panels" was bad, you ain't seen nothin' yet.)
Paul Ryan's plan - to give seniors vouchers they can cash in with private for-profit insurers - would be even worse. It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.
So what's the answer? For starters, allow anyone at any age to join Medicare. Medicare's administrative costs are in the range of 3 percent. That's well below the 5 to 10 percent costs borne by large companies that self-insure. It's even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it's way, way lower than the administrative costs of individual insurance (40 percent). It's even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.
In addition, allow Medicare - and its poor cousin Medicaid - to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.
Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long- term budget crisis would be sharply reduced.
Let me say it again: Medicare isn't the problem. It's the solution.
[This is drawn from a post I did in April, also before current imbroglio.]
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Robert Reich is Chancellor's Professor of Public Policy at the
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http://www.latimes.com/news/opinion/commentary/la-oe-yarrow-oil-leases-20110726,0,7950599.story
Tim DeChristopher's courageous bid to save our world
In disrupting a federal auction of oil and gas leases, Tim DeChristopher became a hero, but he now faces as many as 10 years in prison.
By Peter Yarrow
LA Times Op-Ed: July 26, 2011
In March, Tim DeChristopher was convicted of two felony counts for a nonviolent act of civil disobedience. Acting out of his deepest convictions and his abiding concern for the survival of humankind, Tim bid on oil and gas leases on federal land that he didn't have the means to pay for. On Tuesday, he could be sentenced to a maximum of 10 years in prison for his actions.
The auction Tim disrupted was being conducted during the final weeks of the George W. Bush administration, in what many believed was a push to sell one last batch of public leases before President Obama took office. Tim's intention at the December 2008 auction was to prevent the parcels, some of them on scenic land near Arches and Canyonlands national parks, from going to oil and gas companies.
On the eve of Tim's trial, I went to
Tim is a hero to me, the kind of hero Peter, Paul and Mary stood up for consistently over the last 50 years. Throughout American history, acts of civil disobedience have led to change. Think about the Underground Railroad that helped escaped slaves to freedom, or about the courageous actions of people like Rosa Parks, who refused to stay in the back of the bus simply because of their skin color. Without this kind of defiance of unjust laws, our country would likely still be denying people of color basic freedoms.
Now Tim has taken a stand against federal energy policies and the way they further global warming. At our concert for him, Bethany and I sang "If I Had a Hammer" and "Blowin' in the Wind," the songs Peter, Paul and Mary sang at the 1963 March on
The judge should and will render his judgment in the case of DeChristopher, or "Bidder 70" as he was known at the auction. Part of committing an act of civil disobedience is facing the penalties. But because Tim's act was part of an attempt to prevent greater harm to humankind, I hope the judge will be merciful and will give him a token or suspended sentence.
At his trial, Tim was prevented from explaining the ethical and moral motivation for his acts to the jury. It is appalling that both the judge and the government's prosecution team have pursued Tim's civil disobedience trial as if he were a simple criminal who broke the law without reason or conscience. Doing so deprived him of the opportunity to sway the jury with the moral force of his motive.
In their sentencing memo, the government's attorneys wrote: "A significant prison term will promote respect for the law.... To be sure, a federal prison term here will deter others from entering a path of criminal behavior." The same might have been said of King, had our government been so odiously disrespectful of his moral courage at the time.
The prosecution has maintained that Tim's actions cost the Bureau of Land Management — and hence taxpayers — hundreds of thousands of dollars. In fact, after the auction was concluded, an environmental group got an injunction against many of the leases on the grounds that the environmental consequences of drilling hadn't been adequately considered. Subsequently, Interior Secretary Ken Salazar pulled back the majority of them for further review. Eleven of the 14 auction parcels on which Tim made the highest bid later were pulled back by the government for reanalysis, so his action cost the government nothing on those. As to the remaining three parcels, if they are brought to auction again, they might well fetch more than Tim's original bid. So how did this cost the government money?
It's true that Tim entered the auction building with the intention of impeding its progress, but the specifics of his actions were not premeditated. He has said that the option of becoming a bidder didn't enter his mind until he got to the registration desk, at which point he realized that registering as a bidder might be the best way to derail the auction, or at least to save some parcels of lands from despoliation.
His objective, of course, was to call the entire process into question and ignite public concern over the relationship between such auctions and global warming's ominous shadow. I believe he achieved this mightily.
There is a massive complicity in
Peter Yarrow, a member of the folk-singing trio Peter, Paul and Mary, is a lifelong activist.
Copyright © 2011, Los Angeles Times
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