Wednesday, July 29, 2009

Notes on HR 3200: A response to Rick Joyner's "Special Bulletin: National Health Scare"

The health care reform debate is a huge topic right now and there is much heated rhetoric flying back and forth. But how do we know who is right? How do we know what to believe?

Dana and I have been interested in health care reform for about 2 years now and support a single payer system. We see fundamental problems with how the profit motive has conflicted with quality health care in the US private insurance market.

In the past few days we have received a link to something that Rick Joyner wrote about the health care bill being currently considered in the House of Representatives. It contains a number of claims that Dana and I find to be suspicious - especially the claim that this bill would encourage euthanasia and set a massive bureaucracy which would decide who lives and who dies (i.e. what care will be given or not). Rick likened this bill to Nazi Germany or Stalinist Russia.
These are big claims and must be examined. At the end of the bulletin is an "outline of this bill [HR 3200] put together by Mat Staver of the Freedom Foundation and Liberty Counsel"

This outline of the bill is what prompted me to actually read the bill. Dana and I support change to the health care system, but we really should be looking at what exactly the bill actually says. The Devil is in the details.

Therefore what follows are links to the house bill, the afore-mentioned Bulletin and a set of notes I will be taking as I read through the bill.

Links:
Special Bulletin: National Health Scare by Rick Joyner
Text of HR 3200 (PDF)

Huffington Post also has HR 3200 available for reading online where one can leave specific questions or comments about lines in the text. The Link is:
http://www.huffingtonpost.com/2009/07/14/health-care-bill-released_n_232206.html

Notes:
  • Pages 1-5 outline the purpose of the bill.
  • Pages 5-8 lay out the contents of the bill.
  • pp.8-14 - definitions.
  • p.15 - January 1st 2013 is when government regulations begin for "Qualified Health Benefit Plans" (QHBPs) - all new health insurance plans, public or private, would be regulated for "affordable coverage," "essential benefits," and "consumer protection"
  • p.16 - all insurance plans that began before Jan. 1 2013 will be "grandfathered" into the system.
  • p.17
    • "RESTRICTIONS ON PREMIUM INCREASES.—The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner."
    • In other words, insurance premiums cannot be increased for any individual without also increasing the premiums for all others in the same "risk group"
  • p.17 - Grandfathered plans will have 5 years grace period to comply with new regulations.
  • p.18 deals with exceptions
"Subtitle B—Standards Guaranteeing Access to Affordable Coverage"
  • p.19 - (IMPORTANT!!!) This Law (if passed) will prevent health insurance companies from denying coverage to patients on the basis that they have some preexisting condition or other health problems.
  • p.20 - Health insurance companies will not be able to dump coverage of a patient without notice.
    "Rescissions of such coverage shall be prohibited except in cases of fraud as defined..."
  • p.21 - sets up regulations on price variations by age, area, and individual vs. family rates so that the prices can't be excessively high for one group.
  • p.22 - sets out rules on how the health commissioner will study the effects of this health reform bill and report to congress after a year and a half.
  • p.23&24 - This section empowers the health commissioner to lay out rules to prevent discrimination in health benefits.
  • p.24 - (IMPORTANT!!!) The Health Comissioner will set a minimum "medical loss ratio" - the percentage of each dollar from insurance premiums that insurers spend on actual health care. If the company spends less on health care than the minimum medical loss ratio then they have to refund their clients.
  • For instance, if the comissioner requires 90% of each dollar to be spent on actual medical care (instead of overhead costs or profits) but an insurance company only uses 80% of their income on providing medical care, then they would have to repay their customers the 10% not used on actual health care.

  • The commissioner is to set the "highest level medical loss ratio possible ... to ensure adequate participation ... competition in the health insurance market ... and value for consumers so that their premiums are used for services."
Subtitle C—Standards Guaranteeing Access to Essential Benefits
  • pp.26-7 - Limits cost-sharing, gets rid of annual or lifetime limits on insurance payments.
  • pp.27-8 - Essential Benefits include: hospitalization, outpatient and emergency services, prescription drugs, rehabilitation, mental health & substance abuse services, preventative health, vaccines, maternity care, baby & child care...

  • p.29 - (IMPORTANT!) Contrary to the claim made in Rick Joyner's bulletin that page 29 in the health care bill establishes health care rationing, this section of the bill actually caps the amount of pocket money a person must put out for medical treatment and stops the use of "co-insurance" where the insurance company only pays a percentage of a medical bill.
  • pp.30-7 - Establishes an "advisory committee" of "medical and other experts" (who will not be Federal Employees!) called the "Health Benefits Advisory Committee." They will "recommend covered benefits and essential, enhanced, and premium plans." Members of the board are to be drawn from all parties involved (doctors, consumers, insurance companies, unions, employers, financial experts, etc.) so as to "represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee."
  • (IMPORTANT!) Contrary to the portrayal in Rick Joyner's bulletin of a "government committee that decides what treatments/benefits you get," this committee will actually be composed primarily of non-government sector experts who will be establishing minimum standards of care that insurance companies may not go below.
  • The way the system operates now is that insurance companies regularly deny coverage of, or restrict treatments in order to save as much money as possible (their real goal is the maximization of profits after all). This bill has set up a correction for this problem. Pages 26-8 set out minimum requirements for care and pages 30-5 merely establish a committee which will be responsible for updating and clarifying these minimum standards.
  • pp.36-7 - Adoption of Advisory Committee's Recommendations - The Secretary of Health and Human Services will either adopt the standards set by the committee or send back the recommendation for review.

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Friday, July 24, 2009

America’s Role in the World: Morality, Hypocrisy and National Interests

Growing up here in America, the ideas of what America stood for in the world were ideas of greatness, leadership, honor, courage, justice, equality, democracy and freedom for all. I saw America as a light in the darkness, a city on a hill, a beacon of hope. The American dream was the dream of freedom, opportunity and prosperity. I had little reason to doubt this narrative. Everyone I knew believed this, my schooling reinforced what they said, and politicians of both parties appealed to these great “truths.” And judging from talks with friends and family, this vision of America’s role in the world remains strong. Unfortunately the popular notions of what America stands for and the facts of American foreign policy are hardly connected. The rhetoric is almost Orwellian, but the truth is waiting for those of us who have caught a hint of the hypocrisy. However, undertaking a research project and questioning comfortable assumptions are not things most Americans feel inspired to do. The horrors of September 11th 2001 caused many Americans to question why anyone would hate America so much. Unfortunately President Bush painted terrorists as irrational agents of pure evil who hate us for our values and our freedoms. The problem is, that’s just not the case. As Jim Wallis says:
It is impossible to comprehend adequately the terrorist attacks of September 11 without a deeper understanding of the grievances and injustices felt by millions of people around the world. That is a painful subject that the US government mostly refuses to engage, the media avoid, and many Americans are unable to hear when they are feeling such mourning, grief and anger. …But the US policies that most anger people around the world are generally unknown to most Americans... (Wallis 96-7)

Given this, we must ask the question: What are these policies that anger people around the world, and why would the US pursue such policies? In answer, I argue that contrary to popular perception, foreign policy has been driven by a philosophy of “political realism” (a.k.a. power politics) with the aim of achieving so-called “national interests” by whatever means possible while masked in language about democracy, freedom and security. I will explore the examples of Iran from the 1950s to ’79, Colombia from the Cold War to present, and Pakistan as an ally in the “War on Terror.”

Although not totally uniform, political realism can be defined as “a school of thought that explains international relations in terms of power.” (International Relations, 35) Realism emphasizes states as primary actors exercising power for self-interest in an inherently anarchical international community. International law and codes of morality are seen as mostly irrelevant because self-interest is the primary motivator. Realists have tried to understand international relations in terms of the reality that people and thus states act in perceived self interest. On the other side of the spectrum is the idealist or liberal position, which emphasizes states as acting within an international community where law and norms should play a significant role. Realists have “blamed idealists for looking too much at how the world ought to be instead of how it really is.” (International Relations, 36) In reality, American foreign policy has been directed by a mixture of these positions in complex ways but, as I will show, perceived interest has played a decisive role in causing the US to support actions totally opposite of our stated American values. Even when US presidents have been seen as being motivated ideologically rather than through cold calculated interest, this has been the case. The question of whether the Bush or Reagan administrations believed their own rhetoric that they were fighting “evil” and thus could not negotiate with “evil” is beside the point. They both worked with clearly evil regimes to advance “national interests.”

The issue of self-interest when talking about states is problematic. The realist assumption that states are unitary actors is merely an oversimplification. States are made up of many different groups and individuals – interest groups, bureaucrats, politicians, lobbyists and the public in general – who compete to determine which interests will be represented in foreign policy decisions. Issues of group psychology, cultural norms and competing models of decision making, complicate this. However, generally speaking, those with more power and resources at their disposal, i.e. business interests, will inevitably have a louder voice and dominate the agenda. American foreign policy often does not represent what is in my best interest. Human rights usually take a back seat to the material interests of the powerful. George Kennan, the “architect of the US’ cold war grand strategy of containment… summarized the role that the US policy was to play in fashioning a global political economy conducive to US interests in the immediate post-war period. Kennan argued that ‘[The US has] about 50% of the world’s wealth, but only 6.3% of its population … [thus] Our real task in the coming period is to devise a pattern of relationships that will permit us to maintain this position of disparity’.” (Stokes, 371)

The example of US’ support for the Shah of Iran is a significant one. In 1951, the Shah Mohammad Reza and The Anglo-Iranian Oil Company (later British Petroleum) were facing a huge danger in an outbreak of democracy. The British were profiting in a major way from the Anglo-Iranian Oil Company which had sole claim to Iranian oil, giving to Iran only a token amount of profit. After WWII, “a loose coalition…known as the National Front” sought to restrict the monarchy and enact reform. “Most important, the National Front, angered by years of foreign exploitation, wanted to regain control of Iran's natural resources, and, when Mosaddeq became prime minister in 1951, he immediately nationalized the country's oil industry.” (Britannica) Britain naturally opposed this as the major beneficiary of the previous relationship and placed an embargo on Iranian oil with the help of the Americans whose oil companies would later gain a large stake in Iranian oil. In operation Ajax, the CIA staged a coup overthrowing the democratically elected government, and reinstating the Shah as the absolute monarch in 1953. The Shah then proceeded to oppress all opposition to his rule. “All forms of social and political protest, either from the intellectual left or the religious right, were subject to censorship, surveillance, or harassment by SAVAK, and illegal detention and torture were common.” (Britannica) Douglas Little points out the role of the US thus:
…After considerable prodding from Washington, in 1957 the shah created SAVAK, a Farsi acronym standing for the National Intelligence and Security Organization. Headed by Teimur Bakhtiar and trained by the CIA, for two decades the SAVAK relied on Gestapo tactics—arbitrary arrests, torture, and murder—and a huge network of informers to snuff out opposition… A quarter century after Operation Ajax, the shah’s Iran had become an oil-rich police state, thanks in large measure to help and encouragement from U.S. intelligence. (Little 666)

As we can see, behind the history of the US enmity with Iran which lasts till today, the reason for the Iranian uprising in 1979 is the not so oft spoken of subversion of their democratically elected government, CIA training of secret police and use of torture, all in the name of upholding American national interests.

Iran however is not a lone anomaly in the history of US foreign policy. US support of oppressive dictatorships in South and Central America such as Chile under Pinochet, and the training of soldiers in the School of Americas using manuals which “advocated torture, extortion, blackmail and the targeting of civilian populations” (SOA Watch) have a long history. “During the cold war the US intervened in more states in Latin America than on any other continent, with US sponsored counter-insurgency (CI), the primary means of US coercive statecraft.” (Stokes 368) From the Cold War period up to today, Colombia has been among the biggest recipients of US military aid. On the face of it, this policy seems justified. Colombia is a democracy fighting communist guerillas and the drug trade. However, the methods used by the Colombian military and paramilitaries have suppressed democracy for years. An AI report on US military aid to Colombia says “Colombia has been one of the largest recipients of US military aid… Yet torture, massacres, ‘disappearances’ and killings of non-combatants are widespread and collusion between the armed forces and paramilitary groups continues to this day.” (Amnesty)

In Colombia during the Cold War, just as in the war on terror, there was no obvious way to tell an insurgent from anyone else unless they engaged in combat. Thus, labor leaders, human rights activists, dissidents and opposition leaders, educators, and religious leaders who criticize government policies have all been targeted by the military and by paramilitaries. Increased participation in labor unions, student activism, protests, strikes, letter writing to criticize the government and “the appearance of questionable doctrine in the educational system” have all been seen as signs of potential threat. (Stokes 373-374) This policy appears not to have changed. Amnesty International points out that
“The Colombian Commission of Jurists has documented that between July 2002 and June 2005 [paramilitaries] assassinated or forcibly disappeared an average of 1,060 persons each year. Just recently, on January 31, 2007, a human rights defender named Yolanda Izquierdo was killed in the Department of Cordoba by gunmen suspected of being linked to army backed paramilitary groups. …Meanwhile, reports documenting the ongoing direct responsibility of the security forces in human rights violations, including reports issued by the United Nations, are abundant.” (Amnesty)

Human Rights Watch points out that “Colombia has for years had the world’s highest rate of killings of trade unionists. …more than 2600 since 1986… The suspected killers are often members of mafia-like paramilitary groups which have had close ties to military, political and business figures. In 95 percent of cases, the killers have never been caught or prosecuted.” (Roth) Regardless of the justifications of fighting drugs or terror, the policy is totally contrary to American values, yet “despite overwhelming evidence of continued failure to protect human rights the State Department has continued to certify Colombia as fit to receive aid… [continuing] a policy of throwing "fuel on the fire" of already widespread human rights violations, collusion with illegal paramilitary groups and near total impunity.” (Amnesty)

The more we look into the dark history of US foreign policy, we find that the torture, abuses and contempt for international law are not limited to the recent war on terror that President Bush declared after 9-11 but are merely the latest revelations of such action. The policy of support for Colombia in spite of abuses continues today, as does US support for Pakistan as a key ally in the war on terror. Musharraf, the president of Pakistan who took power unconstitutionally was a serious offender of human rights and as of 2006 Human Rights Watch “documented a pattern of ‘disappearances,’ arbitrary detention, and torture by the Pakistani security services in counterterrorism operations across Pakistan.”

The problem is, that it is precisely this history of hypocrisy which has caused untold grievances, not only in the Muslim world but on nearly every continent, that has sparked the anger and hatred of those who oppose US hegemony. US officials spout beautiful rhetoric about promoting freedom and respect for human rights and then turn around and promote so-called national interests at the cost of all that our great nation supposedly stands for. Clearly this pursuit of hegemonic power to dominate the international system has worked against us. We’ve sold our souls for wealth and are paying the price. Nevertheless, I believe our nation can be great, as a leader in democracy, freedom, and the pursuit of peace around the world. This will take a true commitment to place human rights at the top of our agenda. This can be accomplished only when we as Americans get informed and practice true democracy by demanding that our leaders refuse to pursue narrow and shortsighted interests and be true to our great ideals.

Sources:
Wallis, Jim: God’s Politics: Why the Right Gets It Wrong and the Left Doesn't Get It. Harper Collins, New York. 2005.

Goldstein, Joshua S. & Pevehouse, Jon C. International Relations – Brief Fourth Edition. Pearson Longman, New York. 2008.

Stokes, Doug. ‘Iron Fists in Iron Gloves’: The Political Economy of US Terrorocracy Promotion in Colombia. British Journal of Politics and International Relations: 2006 Vol. 8 pp. 368-387.

"Iran." Encyclopædia Britannica. Encyclopædia Britannica 2007 Ultimate Reference Suite . Chicago: Encyclopædia Britannica, 2008.

Little, Douglas. Mission Impossible: The CIA and the Cult of Covert Action in the Middle East. Diplomatic History Nov2004, Vol. 28 Issue 5, p663-701.

School of Americas Watch (SOA Watch): SOA Manuals Index; Accessed March 6th 2008
http://www.soaw.org/article.php?id=98

Amnesty International. US Military Aid To Colombia. Accessed December 1st 2008
www.amnestyusa.org/all-countries/colombia/us-military-aid-to-colombia/page.do?id=1101863

Roth, Kenneth. Delay Consideration of Colombia Trade Deal. Human Rights Watch. Nov. 14 2008. Accessed Nov. 30, 2008. www.hrw.org/en/news/2008/11/14/delay-consideration-colombia-trade-deal

Pakistan: Torture in Counterterrorism Should Top Blair Agenda. Nov. 16, 2006. Accessed Nov. 30, 2008. www.hrw.org/en/news/2006/11/16/pakistan-torture-counterterrorism-should-top-blair-agenda

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News of the Big Move

It's been a long time since we've written anything here. Bloomsburg University has been a great place for Joel but the work load has meant leaving off writing here. Now however after 3 semesters at Bloom U, Joel is transferring to University of Pennsylvania. He will be majoring in philosophy and South Asian studies. We are very much looking forward to this move to Philadelphia where we will be back on our own again.
Thanks for keeping up with us.

Peace

An Open Letter to the Editor and to our Representatives on Health Care

The “Medical Loss Ratio” is what tells investors how profitable an insurance company is. It measures the percentage of each dollar paid in on premiums is actually used for patients’ medical expenses. The average is around 75% (down from 95% in the 1990s).

The goal for profit industry is to maximize profit for investors. In other sectors of the economy this works well. However, with health insurance companies this means that rather than providing quality care to patients who need it, the business focuses on reducing the Medical loss ratio as far as possible. To satisfy Wall Street they actively seek to insure those who are statistically the healthiest while dumping those patients who are the most costly. Is this how health care should operate? With an insurance company bureaucrat standing between you and your doctor?

Health insurance companies systematically use preexisting conditions to deny coverage to patients who get sick and become a cost to the company. Over half of all bankruptcies are due to medical costs. Roughly one in six Americans are uninsured. Although the medical equipment and training in America are among the best in the world, this has not translated into a healthier society.

We must reform the system. Health care must be a guaranteed right provided to all, no bureaucrat standing between a patient and their doctor. Who can accomplish this? We the people can and must. Our elected representatives have the moral responsibility to represent the people’s interests.