America Still Needs Medicare for All

The competition for the Democratic Party nomination between Hillary Clinton and Bernie Sanders is definitely heating up as we start the primary election season. Although it lacks the venom of the Republican fight, Hillary and Bernie have some serious disagreements on the issues (unlike Hillary and Barack Obama back in 2008) which will give voters more of a real choice of whom to vote for.

Hillary, citing her pragmatism, wants to make incremental changes to our government to make improvements. Bernie believes the system is broken and nothing less than revolutionary change is going to effectively address our problems.

Nowhere is this contrast more evident than their positions on how to improve health insurance for Americans. Hillary feels that working with the Republicans to improve the Affordable Care Act (better known as Obamacare) makes far more practical sense than trying to replace it with a more controversial single payer system that Bernie (and I) advocate.

For those not familiar with what ‘single payer’ insurance means, here is a brief explanation. In the US, health insurance (for those under 65) is purchased from a network of private insurance companies. By contrast, a single payer system uses the government to take the place of the private insurance companies. It alone collects premiums (in the form of taxes) and it alone pays benefits when needed to its citizens.

Contrary to conservative rhetoric, single payer (along with the dreaded Obamacare) are not a “government takeover of healthcare”. The actual providers of the care do not work for the government (as opposed to those working for the Veterans Administration).

In the US, single payer as a political position is too hot to handle except for the most liberal politicians (such as Bernie Sanders). But despite its reputation in the US, single payer is the de facto standard for health insurance in most of the rest of the industrialized world. And for good reason! Single payer systems are much more cost-effective due to their lower overhead and lack of a profit motive compared to private insurance - and all of its citizens are covered! As still another dubious example of American Exceptionalism, only Americans among those in the industrialized world are subject to financial ruin just for getting sick!

So can such a seemingly controversial idea as single payer work in the US? Well, it does already in the form of Medicare for those over 65! Advocates like Sanders just want to expand the Medicare program to all Americans. Yes, Medicare does have its problems but it does work despite only covering the oldest and sickest among us. Adding all of the remaining younger and healthier people to the risk pool can only make the program more viable.

So circling back, can Obamacare be improved to offer the same advantages as those provided by a single payer system as Hillary is advocating?

Let’s start out by saying that Obamacare was a great step forward for America because it addressed the problem of those with preexisting conditions not being able to get insured. And Obamacare has recently celebrated a milestone in now insuring over 90% of Americans! Whoopdee doo!!

But in a nation of over 300 million, that means we have about 30 million who are still without health insurance in addition to many millions more who are underinsured. A couple of weeks ago, 60 Minutes reran a story about what is known as the Health Wagon, essentially a large repurposed Winnebago winding its way through Appalachia back roads to provide free medical care to its many people who despite Obamacare, still do not have access to health insurance.

Many of those stepping aboard the Wagon were obviously quite sick from neglect because they couldn’t afford a doctor. Some eventually died because help came too late. It was heartbreaking to watch. Here is the video link so you can watch this if you haven’t already. All I could say to myself out loud over and over was, “We can do better than this!”

So finally, what about the politics around all of this? Whatever the merits of an idea, it is unfortunately politics that often determines what turns a dream into reality.

It has been said that single payer is impossible in the present political environment so pursuing it is little more than tilting at windmills. But when it comes to trying to improve Obamacare, the Republicans in Congress have made it quite clear that their obsession is not to improve Obamacare but to destroy it. Sorry, Hillary!

So if the half loaf requires just as much political heavy lifting as the full loaf, why not just go for what we want and need in the first place? And as long as Obamacare is still around to serve as a placeholder, we have nothing to lose by going for what’s best for our nation as a whole!

It is worth noting that the great social advances in our history such as Civil Rights, the end of slavery, and women's suffrage were also at one time, politically impossible. But if enough of us can mobilize behind a truly important cause like making access to affordable healthcare a right for all Americans, we can move mountains! Giving up is just not an option!

America Must Do Something About Its Drug Pricing

Every so often, there is somebody in the news who stirs up almost universal outrage. In late 2015, that person would almost certainly be Martin Shkreli.

Mr. Shkreli has emerged as a symbol of pharmaceutical greed for acquiring a decades-old drug used to treat an infection that can be devastating for babies and people with AIDS and, overnight, raising the price to $750 a pill from $13.50. His only mistake, he later conceded, was not raising the price more.

When Shkreli was shown after being arrested, it brought cheers to many even though his arrest for securities fraud had nothing to do with his controversial drug pricing.

You would think that someone so reviled would provide a great business opportunity for somebody to sell dartboards with his likeness on them. And you would be right.

But in fairness, many others have received the same treatment from Kentucky anti-gay marriage activist Kim Davis to…the Pope???

Shkreli defends himself by saying that he was only doing what any good CEO would do which is to make as much profit for his company as possible. True enough. But at what cost to others?

And while Shkreli enraged many because of the blatant cockiness behind his pricing tactics, is this any worse than what so-called Big Pharma is doing to the American people?

...in some ways, Mr. Shkreli, chief executive of Turing Pharmaceuticals, has taken the heat off other drug companies.

Most drug companies do not increase prices fiftyfold overnight, as Mr. Shkreli did.

But they often increase prices 10 percent or more a year, far faster than inflation. And those 10 percent increases — on drugs for common diseases like diabetes, high cholesterol and cancer — have a far bigger impact on health care spending than the 5,000 percent increase on Turing’s drug, Daraprim, which might be used by about 2,000 people a year facing possible brain damage from a parasitic infection called toxoplasmosis.

The marketing of cancer drugs has drawn particular attention. Check out this TV ad, A Chance to Live Longer.

So you may ask, how much does this drug Opdivo (in combination with another drug, Yervoy) cost?

The cost of cancer treatments has drawn scrutiny from doctors such as Leonard Saltz of Memorial Sloan Kettering Cancer Center, who estimated earlier this year that the Opdivo-Yervoy combination would cost the average patient $295,000 for a little less than a year of treatment. If all advanced cancer patients in the U.S. received drugs at that estimated price, he projected, the total cost would reach $174 billion per year.

There are a number of very difficult ethical and practical considerations here.  In addition to the astronomical cost is the knowledge that the drug will likely only extend life by a few months. According to the video, "half of the Opdivo patients were alive 9.2 months versus 6 months for chemotherapy". And on top of that, the proposed drug combination according to the article has a much higher toxicity rate.

Decisions on how or whether to use drugs like these can only be done by the specialist. But here is a drug being marketed directly to patients who are in a fight against end-stage cancer which really comes across as preying on their desperation. This is another (albeit an extreme) example of why it is unwise to have prescription drugs marketed directly to consumers. As another example of 'American Exceptionalism', America is the only country in the world (other than New Zealand) that allows this!

Presumably one of the rationales behind giving pharmaceutical companies a free reign on pricing is to be assured that there will be enough profits for research to find future drugs. But these companies spend far more on marketing than research.

In addition, the lack of a universal health insurance system in America creates a system with higher drug prices.

The US is an outlier among industrialized nations: it’s the only rich country that does not offer a publicly funded health system, relying instead largely on private insurance. This affects the pricing of drugs in several ways that are independent from the actual regulations imposed on pharmaceutical companies.

First, and perhaps most importantly, the power in setting the price for drugs is skewed toward drug manufacturers. Unlike countries where universal health coverage is in place, the negotiating is left to individual care providers rather than being in the hand of a large, publicly funded buyer that’s able to negotiate since it purchases most (if not all) of the drugs.

Just to add insult to injury, the US does have its own universal health coverage but only for those over 65 in the way of Medicare. But at Republican insistence, Medicare is barred from negotiating for lower drug prices!

So while the issue of drug pricing in the US is a complex one, there is much that can and should be done to improve the situation for Americans. Drug pricing has become an issue in the upcoming presidential election (at least for the Democratic candidates). It is up to us voters to make our voices heard on this issue!

A Plea on Behalf of the Pig

So what's your favorite animal? Of course most of us would probably pick dogs or cats since they have provided us with great companionship through the years. But the animal I find to be the most interesting is the pig.

The pig has had an incredible history in its service to mankind. Two interesting books on the subject that I recommend to the reader are Lesser Beasts: A Snout-to-Tail History of the Humble Pig along with Pig Tales: An Omnivore's Quest for Sustainable Meat which discusses the cruel treatment of these noble creatures by our modern factory farming.

The pig was among the first food animals domesticated by man which eventually became a reliable food source for a countless number of civilizations throughout history. Unlike other domesticated animals like sheep and cows which required land to graze, the pig could live just about anywhere that had garbage or table scraps to feed them. In fact, the pig also served as a sanitation service before more modern methods came along.

And unlike other large domesticated animals that reproduce offspring one at a time, pigs are very prolific and grow very quickly. A sow can produce 2 litters of about 10 piglets each per year. To ensure a reliable source of food in the New World settlements, pigs were brought across the ocean by Columbus along with other explorers. Once a small starter population of pigs was dropped off in the newly settled land, it didn't take long to acquire a sizable population to provide ample subsistence for the settlers.

Today, pork is the most widely eaten meat in the world even though Muslims who comprise almost a quarter of the world's population abstain from it.

But pigs are interesting for more reasons than just their value as a source of food.  

This is from Pig Tales, Page 19:

Pigs are by far the most intelligent animals we have domesticated. Research shows that a pig has the mental capacity of a 3 year old human. They have been taught to solve complex puzzles and even play computer games. And pigs have been our constant companions throughout the rise of modern cultures.

In addition to being exceptionally intelligent, pigs are very sociable and affectionate along with often possessing many personality traits that we normally associate with humans. So not surprisingly, there can often be a blurring between their role as a food animal and as a companion for their owners. 

This is from Lesser Beasts, Page 188:

When a cottager kept a careful account of his expenditures on a pig he sent to market and upon selling it calculated that he had made three shillings. "Not much profit there," he was told. "No," the man replied. "But there: I had his company for 6 months."

And this is from Lesser Beasts, Page 191:

Pig killing was a communal ritual, a break in the rhythms of daily life, a sign of the passing seasons. It was a solemn occasion - the pig was a friend and did not want to die - and a time of celebration. This drama was peculiar to pigs because cattle and sheep were rarely kept around the house. Only pigs were cuddled and then killed, their horrifying human like shrieks piercing the neighborhood. One girl recalled that during the slaughter, she would "creep back into bed and cry," remembering how she had fed cabbage stalks to her beloved swine. The next day, however, she happily dipped her bread into pork gravy made from the same pig's flesh. She was just a girl, she said, "learning to live in this world of compromises."

But today, the quaint interaction between the farmer and his pigs has been almost totally replaced by factory farms where thousands of pigs are doomed to a life of severe confinement and often cruelty before meeting their ultimate fate.

When it comes to factory farms, there's good news and bad news. The good news is an abundance of cheap pork. But the bad news is the environmental costs along with the often cruel treatment of these animals.

For the reader who wishes to learn more about the issues concerning pigs and factory farms, there is this NPR interview of the author of Pig Tales, Barry Estabrook.

So where do we go from here? No, we are not all going to become vegans. And no, we are not going to be able to totally eliminate factory farms. But there are some incremental improvements we can and should make.

First and foremost, we need to eliminate the ridiculous animal welfare double standard we have for companion animals as compared to those animals we use for food. For example, inflicting cruelty to dogs can result in a prison sentence and widespread public condemnation like what happened to NFL quarterback Michael Vick while inflicting even the worst conceivable cruelty to a pig is, to my knowledge, not even illegal.

One more example. What if someone were to keep a dog in a transport crate for an indefinite period of time? I know, I'm sick to even think of something like this. But sows whose function is to deliver and nurse their piglets are often subjected to this exact treatment in what are called gestation crates. Subjecting animals of this level of intelligence to this cruel treatment has been known to make them insane! Indeed, gestation crates are considered to be so cruel - even by factory farming standards - that they are now banned in the UK and partially banned in the European Union. But not in most of the US.

The driving force behind all of this is profits - the more animals that can be squeezed into the smallest space - the more money can be made. Regulations requiring humane amounts of living space per animal would go a long way towards alleviating their suffering.

Yes, I know. Food animals like pigs are different than companion animals because the food animal is bred to serve us at the dinner table. True enough. But common decency demands that we at least do our best to avoid inflicting any needless pain or suffering on any living creature!

The Canadians Get Their Country Back

For many of us Americans, Canada is well just...boring. After all, we are mighty America who like Superman is going around the world in a never ending fight for truth, justice, and (of course) the American way!

Why the American way? Many in this country believe in 'American Exceptionalism.' Our country is exceptional; Canada (and presumably every other country) is not!

Perhaps there's no harm to this little bit of self-serving bravado. Or maybe there is! It's easy to get lulled into thinking we are the best at everything we do because we are well...Americans!

But instead of our putting on blinders and refusing to see how other countries do things, we should pay attention to what they do better and perhaps adopt their methods. A great place to start would be our northern neighbor, Canada.

Canada over the last nine plus years had been subjected to the very conservative policies of Prime Minister Stephen Harper. Many Canadians feared that they were being pulled so far to the right that they might become another America where extreme conservatives were making Congress almost totally dysfunctional.

So in the recent Canadian election, they threw the (Conservative) bums out including Harper and replaced him with the Liberal Justin Trudeau, son of the late former PM, Pierre Trudeau.

While Canada certainly has its conservatives, its politics overall skews significantly more liberal than in America. For example, Canada has had a single-payer 'Medicare for all' health insurance system for some time now that has had no serious opposition from the Conservatives. In fact, back in 2004, the Canadian Broadcasting Company conducted a nationwide poll of its viewers to determine who deserved the title of The Greatest Canadian. The winner was Tommy Douglas (a social democrat similar to Bernie Sanders) who in Canada is fondly remembered simply as The Father of Medicare.

NYT op-ed columnist Paul Krugman makes this observation in his article Keynes Comes to Canada:

Which brings us to the issue of deficits and public investment. Here’s what the Liberal Party of Canada platform had to say on the subject: “Interest rates are at historic lows, our current infrastructure is aging rapidly, and our economy is stuck in neutral. Now is the time to invest.”

Does that sound reasonable? It should, because it is. We’re living in a world awash with savings that the private sector doesn’t want to invest, and is eager to lend to governments at very low interest rates. It’s obviously a good idea to borrow at those low, low rates, putting those excess savings, not to mention the workers unemployed due to weak demand, to use building things that will improve our future.

Unfortunately, this sensible bit of mainstream economic wisdom is at odds with most of the rest of the First World economies which are trying to fight unemployment by government spending cuts to try and balance their budgets (aka austerity) - which in most cases is making things worse!  In addition, Krugman points out that because the Canadians did not have the extreme fetish for deregulation of their financial markets like in the US, they were largely spared the brunt of the financial crash of 2008.

I would like to refer the reader to a wonderful op-ed Justin Trudeau: Low Expectations, High Relief by Heather Mallick of The Toronto Star which nicely contrasts the Canadian and American mindsets.

The...election defeat of Stephen Harper, the Conservative prime minister of Canada, and the triumph of his most hated rival, the Liberal leader Justin Trudeau, gave many Canadians that rush of feeling they so rarely enjoy: “It’s a girl.” “The lab says it’s benign.” “Your long national nightmare is over.” 

Ultimately Mr. Harper’s problem in this election was that he couldn’t win nationally with just an older, white male, rural base.

This is the same problem that US Republicans have which will make it very problematic for them to win any future national elections.

For Canadians are different from Americans, and we like it that way. We don’t think we’re exceptional; in fact, it’s rather important to us that we’re not, because that would imply that other nations are below par, which would be quite rude. We are a vast, cold country with a small population of about 36 million and it is essential for Canadians to connect with and help one another. Mr. Trudeau understands that; Mr. Harper did not.

The liberal motto: "We're all in this together!"  The conservative motto: "You're on your own!"

But money doesn’t come first here. We’re ambitious. We pay healthy taxes to support a national single-payer health care system, the jewel of our country.

And there is this take on our respective attitudes towards guns:

Take guns, and you may. We have rifles and other long guns but spend time alone with them in the woods to kill wild animals. What other purpose would there be for rifles? 

She concludes with this:

Mr. Trudeau is different. He is a better match for Canadians’ vision of themselves: peaceable, educated, emotionally stable, multicultural.

This is a far cry from the American electorate, especially those on the far right whose vision is largely warlike, anti-intellectual, batshit crazy and xenophobic. 

OK Canada, maybe you are a bit boring. But that doesn't mean there isn't a hell of a lot we Americans can learn from you!

What Makes a Presidential Candidate Qualified?

At the time of this posting, the three leading candidates in the polls for the 2016 Republican presidential nomination, Donald Trump, Dr. Ben Carson, and Carly Fiorina have never served in a government position. In a way, this isn’t too surprising considering the frustration over the inability of the federal government to get anything done. Supporters of these three likely believe that it may take a true outsider to shake things up to get the government working again.

But with no government experience, the obvious question is whether any of the three are qualified for what is perhaps the single most important and demanding job in the world. 

Even a prominent conservative voice, Bill Kristol in The Weekly Standard can’t help but be concerned about it all.

How big a problem is it that the two leading Republican candidates for president aren’t actually qualified to be president? 

…why should we believe that neither Trump nor Carson is qualified to be president? Did you watch the debate? 

Neither Trump nor Carson has much of a grasp of the issues. Neither has a demonstrated ability to govern. 

So how really important is it for a candidate to have “a grasp of the issues “? At first blush, this is an absurd question. Normally, the voters pick their candidate based on where they stand on the various issues.

But this is not a normal election campaign. In Trump and Carson, we clearly have candidacies that are far more personality rather than issues driven. Neither candidate pretends to have a deep understanding of the issues. And furthermore, most of their supporters don’t seem to care.

But especially Trump has had to occasionally answer media questions on how he can be qualified for the presidency with such a shallow command of the issues. His response usually comes in two parts. One is that he will become an expert on the various issues once he is elected (although he doesn’t say how he intends to do this.) And secondly, he proposes to surround himself with some "terrific people" to be his advisers. 

Now even the most knowledgeable president needs advisers. No one person can have the specialized knowledge in a variety of fields to be able to make some of the vital decisions the office demands. But without enough working knowledge of the issues, how does one intelligently choose the right advisers to surround himself (or herself) with?

George W. Bush as a neophyte on national and international politics chose Dick Cheney from his father's administration to advise him on the selection of his vice presidential running mate. Cheney dutifully gathered very detailed background information on each of the prospective candidates before finally surprising everybody by picking himself.

But Cheney wasn’t done ‘advising’ Bush. He then assumed a major role in selecting Bush's other advisers and cabinet – most notably the selection of Donald Rumsfeld as Secretary of Defense. Cheney and Rumsfeld were the prime drivers behind Bush's catastrophic decision to invade Iraq based on faulty intelligence on so-called Weapons of Mass Destruction. This was a decision that even candidate Jeb Bush was forced to admit was a mistake. Some advice!

Then there is the question on whether running a business makes one qualified to be president. Few presidents come from a business background. Most notable were Herbert Hoover and George W. Bush whose presidencies did not turn out well to say the least.

As has been pointed out by many others, the skills to run a business and a government are quite different. A business exists to make the maximum amount of profit for itself. A government does not exist to make a profit but instead provides services for its citizens. And while a CEO gets to issue orders to get results, a president must have political skills to compromise and work with others in their own and the opposition party. The words ‘Trump’ and ‘compromise' just don’t seem to belong in the same sentence! 

Which leads us to temperament. Trump's confrontational and often insulting behavior is well documented – no need to do that here. Carson is much more soft-spoken but equally inflammatory. For some examples, check out 9 of Ben Carson's Most Controversial Quotes to come to the conclusion that Carson is way too flaky to be taken seriously as presidential material. 

While Trump and Carson do not convey “a grasp of the issues”, Carly Fiorina seems to be much more comfortable talking about issues. Like Trump she presents her executive background in business to try and convince voters that she is qualified to be the President. Other than the previous argument that running a business and a government are not the same, by just about every account, Fiorina was a terrible CEO who showed bad judgment in running Hewlett-Packard. 

In the five years that Fiorina was at Hewlett-Packard, the company lost over half its value.

The only stock pop under Fiorina’s reign was the 7 percent jump the moment she was fired following a unanimous board vote. After the firing, HP shuttered or sold virtually all Fiorina had bought. 

In addition, she was infamous for being intolerant and outright hostile towards anyone who disagreed with her decisions. While this may work in the boardroom (at least for awhile), it certainly would not work in a government environment that requires political skills to work with others to get things done.

So clearly, none of these three are qualified to be our next president. But then who is?

Truth be known, few presidential candidates offer the complete package of experience. In general, the candidates for President tend to have a background as either a state governor or a US Senator. Each has its advantages and disadvantages. Senators, due to the nature of their positions usually have a much better command of national and international issues than governors whose daily duties deal with statewide issues. But most Senators have no ‘executive experience’ actually running a government.

Hillary Clinton in addition to her experience as a US Senator and Secretary of State, had an active role in her husband Bill Clinton’s administration. Of those who are running, she is the most experienced and qualified. Vice President Joe Biden (if he runs) has equally strong qualifications. Also worth noting is Senator Bernie Sanders who while he has no gubernatorial experience, had a successful four terms as Mayor of Burlington, VT. 

With the frustration of many over how they see government as not working, government experience is now perversely seen as a disadvantage. But it’s still early! Although right now there is a fascination for candidates who are the ultimate ‘outsiders’, past experience has shown that when the races start to heat up, candidates who have novelty appeal and little substance tend to fade away. But then the demise of Donald Trump's campaign has been predicted for some time now by many expert observers despite maintaining his lead in the polls. Will he do the unthinkable and actually win the Republican nomination?? Nobody really knows for sure. All we can do is stay tuned!