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March 26, 2010

Reforming Health Reform?

(Photos by Robin Holland)

This week, Bill Moyers spoke with journalist John Nichols and women's advocate Terry O'Neill about the health reform President Obama signed into law on Tuesday.

Nichols said that the reform in and of itself is not sufficient, but that it's an important foundation and that activists must now demand further improvements to the nation's health system:

"For a hundred years we tried to create a project. We tried to take this vacant site and dig a hole, put in a foundation, and start some construction. That's what's happened. The fact of the matter is it's best to understand the health care legislation that was passed on Sunday as the beginning of a construction project, and that's why some people fought so hard against it, because they understood [that] once you begin that project, it is very unlikely that we're going to fill the hole in, tear down all the construction... Compromises are always made, and the most important thing is that we're here today screamin' and yellin' about it... The objections that we raise to this health care bill, the demands that we make that it be improved, that we in fact reform the reform - that's what's going to give us a health care system that is humane, that is decent, that is worthy of the United States... Barack Obama is a cautious president. It is time to go out and make him do the things that need to be done. That's an organizing task, and people are ready."

O'Neill said that the health reforms discriminate against women by, for instance, allowing insurers to charge them more for policies and not providing tax dollars to cover abortions, but that the new laws change the conversation and set the stage for an eventual shift to a single-payer system.

"My organization looked at the entire bill at the end of the day when it was passed, and we concluded that on balance, despite the good things that are in the bill, the bill is actually bad for women... What's best about this law, really, is the concept of it. The actual provisions of it are not good, but the concept that in fact the federal government has the largest role to play, the idea that we as an entire society must have health care for all of our people has not been implemented, but the concept is in the bill... We've been told over and over again that gender rating is gone, but it's not. [For] employers with more than 100 employees who buy into a plan on an exchange, the insurance companies will be permitted to charge higher premiums, up to 50% higher for women than for men just because they're women... [And] age rating - the triple premiums being paid by older people has a disproportionate impact on women... It's so crucial that we undo this pernicious idea that somehow federal tax dollars should not be used to pay for abortion. They must be used to pay for all health care needs, including abortion, because eventually where we need to get to is a single-payer system."

While Nichols and O'Neill both believe that President Obama's health reform laws provide an important first step towards a more equitable health system, others argue that they represent a troubling expansion of unchecked government power. Columnist A. Barton Hinkle wrote in the RICHMOND TIMES-DISPATCH that the reforms centralize too much power in the federal government with no mechanism to prevent intrusion into citizens' private lives:

"The increased federal involvement in health care will become a pretext for increased federal involvement in, well, everything. The reasoning will be that individual health affects health care, which is now a federal enterprise. And everything can be said, with more or less sophistry, to affect individual health. So 'managing' the 'system' will become the all-purpose excuse for dictating the manner in which you live your life... Throughout the Bush years, progressives howled as the administration exploited a national-security crisis to expand executive power, while conservatives egged the administration on. Yet neither paused long to note that Bush did not even try to roll back expansions of federal power undertaken in the name of social policy... Obama has also pushed relentlessly for expansions of social welfare and the regulatory state. Every administration expands power where it wishes, but no authority is ever repealed. And so the ratchet tightens."

What do you think?

  • Are you pleased that the health reform bill has been signed into law? Why or why not?

  • John Nichols said that health reform lacked compassion for immigrants, while O'Neill said that it should have paid for abortions. Do you agree? What else would you have included or excluded from the legislation?

  • How are you working to 'reform the reform?'

  • March 5, 2010

    Is the President's Health Bill Worth Supporting?

    (Photos by Robin Holland)

    In January, when Republican Scott Brown won the special election for the Massachusetts Senate seat formerly held by Ted Kennedy, Democrats lost their filibuster-proof majority and the fate of their health reform legislation plunged into uncertainty.

    After weeks of strategizing and negotiation, President Obama made headlines Wednesday by encouraging Democratic members of Congress to pass the Senate's version of the health bill through the controversial tactic known as reconciliation. Originally intended for budget bills rather than more complicated legislation, reconciliation would bypass potential filibusters in the Senate and require only a simple majority of votes in both chambers for passage. Democratic leaders are now working to amass enough support among Democratic Senators and Congressmen, many of whom disagree with aspects of the legislation, to pass the bill despite polls suggesting that a plurality of the public opposes it.

    In this week's JOURNAL, Bill Moyers spoke with two prominent advocates of health reform with very different perspectives on the President's health bill.

    Wendell Potter, a former health insurance executive who has become an outspoken critic of the industry, said that the legislation is flawed but good enough that it should become law:

    "We need to look at this as a win for consumers as well. Yes, it'll be a win for the insurance companies, but I don't think we're gonna wind up with the insurance companies walking away [and] winning the whole ball game. If we don't do anything right now, that's what will happen. They'll win everything... I was distraught when I saw what happened, what I saw the Senate voting on. But then I realized - you know, I studied a lot of these efforts over the past many years to get reform - [that] often we've come short because we've tried to get the perfect, and we've never been able to get anything as a consequence... We need to have a foundation, and this may seem to be not an adequate foundation for a lot of people, but there are more than 50 million people in this country who don't have insurance... Wouldn't you rather, and I think wouldn't most Americans rather, that we have something to start from rather than starting from scratch the next time? It's very hard to build up to doing this in the first place... I'm frankly pretty amazed that we're getting this close to passing something."

    Dr. Marcia Angell, a Harvard medical lecturer and former editor-in-chief of the NEW ENGLAND JOURNAL OF MEDICINE, has advocated for single-payer reform, in which the federal government would provide a national health insurance program for everyone. Angell argued that the current bill would make a bad situation worse and sour the public on further reforms, so Democrats should regroup and push for better legislation in the future:

    "What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the linchpin of health care reform... Not only does it keep them in place, but it pours about $500 billion of public money into these companies over 10 years... and it mandates that people buy these companies' products for whatever they charge. Now that's a recipe for the growth in health care costs not only to continue but to skyrocket, to grow even faster... The President's absolutely right that the status quo is awful. If we do nothing, costs will continue to go up. People will continue to lose their coverage... Things will get very bad. The issue is, will this bill make them better or worse? I believe it will make them worse... Let's say [the bill] is passed. It will begin to unravel almost immediately, and then what will people do? Well, they'll say 'We tried health reform, and it didn't work. Better not try that anymore'... Whereas if the bill dies now, people can say 'This bill died because it was a bad bill,' and the problem is still on the front burner."

    What do you think?

  • Do you think the President's health bill is worth supporting? Why or why not?

  • What do you think should be the goals of health reform, and how are you working to get there?

  • February 5, 2010

    A Single-Payer Solution?

    (Photo by Robin Holland)

    In this week's JOURNAL, Bill Moyers sat down with physician and activist Dr. Margaret Flowers, who was recently arrested for an act of civil disobedience - trespassing - as she attempted to deliver to President Obama a letter urging him to resuscitate the stalled effort at health reform and consider a Medicare-for-all plan, known colloquially as "single-payer."

    Flowers said:

    "I went into medicine because I really do care about taking care of my patients... I really thought that medicine was going to be about taking care of patients, and I learned otherwise - that it was more about fighting with insurance companies and being pushed to see more and more patients. When I looked at what was going on and looked at what works in other places and what models have worked here, I saw that if we have a Medicare-for-all system, then really doctors can practice medicine again... [The White House was] concerned that if we let the single-payer voice in, or if it was associated in any way with [their] legislation, that it would hurt their ability to pass that legislation, so they kind of put the kibosh on it... Why is [Obama] excluding us? Why isn't he letting us be at the table when this makes complete sense from a public policy, public health policy, and economic health policy standpoint?"

    Former Secretary of Labor Robert Reich, who appeared on the JOURNAL last June, argued that single-payer is the best possible health reform but that it is not politically achievable in Congress:

    "The single-payer system would be the best of all... Because a single-payer actually would have huge bargaining leverage, be able to tell the providers what they can do and what they can't do without it being 'socialized medicine.' A single-payer would actually have the reins... But a President, to some extent, has got to be politically realistic. There is no real political option in Congress now for a single-payer... I'm a big single-payer fan. Unfortunately, we cannot get there from here because the political forces are just too strong against single-payer."

    On the other hand, columnist John Steele Gordon of the WALL STREET JOURNAL has argued that, historically, self-interested politicians have proven unable to run large enterprises sensibly. Gordon wrote:

    "It might be a good idea to look at the government's track record in running economic enterprises. It is terrible... Because of the need to be re-elected, politicians are always likely to have a short-term bias. What looks good now is more important to politicians than long-term consequences even when those consequences can be easily foreseen... And politicians tend to favor parochial interests over sound economic sense.... The inescapable fact is that only the profit motive and competition keep enterprises lean, efficient, innovative and customer-oriented."

    What do you think?

  • Do you believe single-payer is the best potential reform for the U.S. health system? Why or why not?

  • In the wake of the Republican Senate victory in Massachusetts that disrupted Democrats' legislation, what health reforms do you believe are politically achievable?

  • How are you and your community working to reform America's health system?

  • December 18, 2009

    Would You Vote for the Senate's Health Legislation?

    (Photos by Robin Holland)

    This week on the JOURNAL, Bill Moyers spoke with journalist Matt Taibbi and economist Robert Kuttner about many progressives’ disappointment with President Obama and, more broadly, the power of special interest groups over both the Democratic and Republican parties.

    Moyers noted that progressives are split on whether to support the Senate’s health legislation, which no longer includes a public option, an expansion of Medicare to people under 65, negotiated rates for cheaper drug costs, or many other progressive priorities for health reform. He asked the guests whether they would nonetheless vote for the bill if they were Senators.

    Kuttner said:

    “It's so far from what I think is necessary that I don't think it's a good bill. But I think if it goes down, just because of the optics of the situation and the way the Republicans have framed this as a make or break moment for President Obama, it will make it easier for the Republicans to take control of Congress in 2010. It will make Obama even more gun-shy about promoting reform. It will create even more political paralysis. It will embolden the Republicans to block what this president is trying to do, some of which is good, at every turn. So I would hold my nose and vote for it... [If] it was up to me to determine whether this bill [will] live or die, I would hold my nose and vote for it even though I have been a fierce critic of the path this administration has taken.”

    Taibbi said:

    “I definitely understand that point of view. My feeling on it is, just looking more concretely at the health care problem, this is a bill that to me doesn't address the two biggest problems with the health care crisis. One is the inefficiency and the bureaucracy and the paperwork which it doesn't address at all. It doesn't standardize anything. The other is price, which has now fallen by the wayside because there's going to be no public option that's going to drive down prices... My feeling is that if you vote for this bill and it passes, that's your one shot at fixing a catastrophic and completely dysfunctional health care system for the next generation, maybe. And I think it's much better for the Democrats to lose on this issue and then have to regroup maybe eight years later or six years later, and try again and do a better job the next time.”

    What do you think?

    If you were a Senator, would you vote for the Democrats’ health legislation? Why or why not?

    November 13, 2009

    Human Faces Behind the Health Debate

    (Photo by Robin Holland)

    This week on the JOURNAL, Bill Moyers spoke with acclaimed actress-playwright Anna Deavere Smith about her latest production, LET ME DOWN EASY, in which she recreates the voices of 20 real people grappling with illness and mortality.

    Smith explained what her production is about:

    “LET ME DOWN EASY is about grace and kindness in a world that lacks that often, [but] not always. And a winner-takes-all world, where we don't think about the people who are losing. We don't think about the people who are abandoned by jobs or governments or lovers or mothers or fathers. [It’s] a call for that kind of grace and kindness and consideration and the metaphor, I think, of death as the ultimate form of loss, possibly our greatest fear – the ultimate form of abandonment. And that in this country we have a hard time looking at death and we have a hard time looking at loss and we have a hard time looking at losing. And I think that doesn't help us be the most caring environment.”

    What do you think?

  • Do you agree with Smith’s view that Americans have trouble thinking about death and loss? Why or why not?

  • What are your personal stories about dealing with illness and mortality?

  • September 11, 2009

    Assessing President Obama's Health Care Speech and Ideas for Reform

    (Photo by Robin Holland)

    This week on the JOURNAL, public health expert Dr. Jim Yong Kim, who is also the incoming president of Dartmouth College, spoke with Bill Moyers about his vision of health and educational reforms for a better future. Dr. Kim commented on President Obama’s health care speech and the Republican response, and offered his suggestions for reforms that would benefit America’s dysfunctional medical system.

    “As a speech, it was really stunning and masterful... But what was most interesting to me was the Republican response afterwards, and how many things that they seem to agree on... One, everyone should have health insurance. Two, we need to lower costs. Three, we need to maintain quality, [and four,] that the expenditures right now in health care, especially public expenditures, are unsustainable... There's no simple solution to this problem... For many, many years, we've been working under the fantasy that if we come up with new drugs and new treatments, we're done [and] the rest of the system will take care of itself... What we've learned about organizations is that it is very difficult to get a complex organization, a group of people, to work consistently toward a goal... What we need now is a whole new cadre of people who understand the science, who really are committed to patient care, but then also think about how to make those human systems work effectively.”

    What do you think?

  • Did President Obama’s speech lay out a practical and substantive vision for health reform in the public interest? Why or why not?

  • Do you agree with Dr. Kim that health reform requires more deep thinking about the delivery of care? Explain.

  • What neglected health reform ideas do you think should be included in health care legislation?

  • Maggie Mahar Answers Viewer Questions - Part II

    We'd like to thank Maggie Mahar for agreeing to answer viewers' questions about the health industry. Below, in no particular order, is her second set of answers, while her first set of answers can be found here.

    Please note that the views and opinions expressed are not necessarily the views and opinions held by Bill Moyers or BILL MOYERS JOURNAL.


    Q: A recent writer complained that she had paid "I think" 50 dollars for a two minute visit with a doctor who gave her a shot. Firstly, I find it hard to believe that a doctor spoke with her, probably took x-rays, and then gave her a shot in two minutes. Even assuming the doctor lunged at her with the injection as soon as he came in the room and the visit really did take 2 minutes- I'm not sure what her complaint is. Should she have been charged 10 or 20 dollars for an injection by a physician. Perhaps she would like to have paid in pennies.

    Maybe I'm the one that is wrong, but yesterday I had an electrician over to my house. He charged me 200 dollars for ten minutes and he didn't even fix the problem. I paid him and thanked him for his time.

    Continue reading "Maggie Mahar Answers Viewer Questions - Part II" »

    September 4, 2009

    Maggie Mahar Answers Viewer Questions - Part I

    We'd like to thank Maggie Mahar for agreeing to answer viewers' questions about the health industry. Below, in no particular order, is her first set of answers. More of her answers can be found here.

    Please note that the views and opinions expressed are not necessarily the views and opinions held by Bill Moyers or BILL MOYERS JOURNAL.


    Q: Comparing Medicare Costs between NJ and Iowa: I suspect that the lower cost in Iowa is primarily due to the difference in re-imbursement rates for the same procedures, rather than fewer procedures.

    Did you look into this?

    -Ed Brown

    A: Ed-

    Thanks for your question. When comparing Medicare costs in Iowa and New Jersey, the Dartmouth researchers adjusted for differences in local prices as well as race, sex and the underlying health of the population. (They have been doing these regional comparisons for more than two decades so they have become very, very good at making adjustments that assure they are looking at apple to apple comparisons.) For their research see .

    Continue reading "Maggie Mahar Answers Viewer Questions - Part I" »

    August 28, 2009

    Ask Maggie Mahar

    Meet Maggie Mahar. You’ll be seeing more of her on the JOURNAL this week, when we present MONEY-DRIVEN MEDICINE, a film produced by Academy Award winning filmmaker Alex Gibney (TAXI TO THE DARKSIDE, ENRON: THE SMARTEST GUYS IN THE ROOM). Ms. Mahar was kind enough to take questions from The Moyers Blog readers, so, over the next two weeks, as you watch the debate over health care reform unfold please submit your questions here. We’ll post her answers after next week’s edition of the JOURNAL.

    [Note: We are no longer accepting questions for Maggie Mahar, but you can read her answers here and here.]

    Why Maggie Mahar? She was kind enough to introduce herself below.

    I began to learn about the healthcare industry while I was a writer and senior editor at Barron’s -- from 1986 through 1997. During that time I covered both Wall Street and Washington, and wrote stories on a wide range of subjects.

    Many of those stories focused on healthcare companies: drug-makers, device-makers, insurers and for-profit hospitals. I also wrote about managed care, the FDA and its battle against Big Tobacco. I analyzed the Clintons’ plans for healthcare reform. I compared non-profit HMOs to for-profit HMOs.

    What I learned, during those years, is that in our health care system, profits often trump patients. A great many people are selling and selling hard. By law, for-profit corporations are supposed to put their shareholders’ interests first: this means that they must strive to maximize profits. And this goes a long way toward explaining why U.S. healthcare is so expensive.

    Continue reading "Ask Maggie Mahar" »

    August 21, 2009

    The Human Toll of America's Health Disaster

    This week, the JOURNAL presented CRITICAL CONDITION, a heart-rending documentary that follows several working families facing a terrible ordeal – getting treatment for ailing loved ones without the aid of health insurance.

    Several people featured in the film speculated that access to public health insurance might have helped them afford basic preventative treatment long before they needed financially devastating emergency care.

    With an estimated 47 million Americans without health insurance, President Obama and others have argued that the federal government should set up a national public health insurance plan to help more families avoid the difficulties captured in CRITICAL CONDITION. Opponents believe a public plan would be a fiscal disaster that would ration treatment and undermine quality of care.

    What do you think?

  • Have you or loved ones faced major illness without health insurance? Please share your stories.

  • Do you believe current proposals for health reform will improve America’s health system?

  • August 14, 2009

    Towards a Healthier Debate on Health Reform

    (Photos by Robin Holland)

    This week on the JOURNAL, Bill Moyers asked three veteran observers for their perspectives on the health care debate playing out across the country. Each suggested that media coverage has presented unhelpful and misleading narratives that have not adequately informed the public about important issues.

    Media analyst Kathleen Hall Jamieson, director of the Annenberg Public Policy Center, argued that raucous town hall meetings have not allowed for constructive dialogue, and that media coverage has further obscured the complexity of the issues:

    “[The town hall meetings are] not creating context in which misinformation on both sides can be corrected, and that’s the problem. We don’t have a deliberative process here taking place in public to inform public opinion. Instead, we’re potentially distorting it... You’d like people to attend, raise legitimate and important questions, give the other side a chance to respond, and then engage in a dialogue about it because then everyone learns. We ought to applaud that. That’s the way democracy should work. And that the attacks are coming from left and right is an important realization. There’s been a tendency in news to feature those that are coming from the right without indicating there’s substantial dissatisfaction from some on the left about the fact that this isn’t single payer.”

    Drew Altman, president and CEO of the Henry J. Kaiser Family Foundation, which focuses on health care issues, suggested that both would-be reformers and the media have confused the public by focusing more on Washington jargon than the human stories of our dysfunctional health system:

    “The debate drifted for a while and the message drifted for a while. It wasn’t defined in terms that average people could understand... People just couldn’t answer the question, ‘What does this mean for me and my family?’ And so they didn’t know what they had to lose if this didn’t happen. But more importantly, that left the field open for the critics and the opposition to define it the way they wanted to and even scare people a little bit that this might be a government takeover of the healthcare sytem... In a sense, what happened was the media and the debate focused on the issues which were in contention on Capitol Hill, that they were debating on Capitol Hill, because media coverage follows the controversies instead of the people issues that brought us this debate in the first place.”

    Republican author David Frum, a former speechwriter for George W. Bush, says that his fellow conservatives have focused too much on opposing Democrats’ proposals at the expense of offering proactive plans for reform:

    “I think what happens for a lot of these political fighters [is] they’re like racehorses. The bugle goes and the blood stirs and there’s a fight and you have to join the fight – and I think there are some tactical opportunities the Republicans see... But if the Republicans win, this is not going to be a great victory for individual liberty. It’s going to be a victory for the status quo... What I am concerned about is in the desire to defeat President Obama, the Republicans are going to fossilize a status quo that is unacceptable to them... If you want to hold the line on the growth of government over the next two decades, this system has to be reformed.”

    What do you think?

  • How well do you think the media has informed the public about the complex issues of health reform? Are the important issues being discussed?

  • In your view, what dimensions of health reform deserve more scrutiny than they’ve received in the media?

    Click here for resources to help fact-check the health care debate.

  • Michael Winship: The Gorilla Dust of Health Care

    (Photo by Robin Holland)

    Below is an article by JOURNAL senior writer Michael Winship. We welcome your comments below.

    ''The Gorilla Dust of Health Care''
    By Michael Winship

    When I was 15, my father was in a near-fatal car collision with a semi-trailer truck. At Strong Memorial Hospital in Rochester, NY, he lay in a coma for two months.

    As the medical bills mounted and the insurance was running out, my mother had to make an agonizing decision. My father would have to be airlifted to the VA Medical Center in Kansas City, where his veteran’s benefits would defray the costs. She would go there with him; arrangements would have to be made for someone to take care of her home and kids while she was away. For how long, no one was certain.

    Miraculously – almost as if he realized what was going on – Dad suddenly emerged from his coma and was released from Strong a short time later. He never fully recovered from the accident, but for that moment, at least, further domestic upheaval and financial chaos were averted.

    Flash forward nearly 30 years and it was my mother who was now in the hospital, diminished physically and spiritually by dementia. Her children made the choice together but it was my sister, who had become her chief caregiver, who bore much of the brunt of the decision not to resuscitate.

    In the months and years prior to my mother’s death, the kind of end-of-life counseling that health care reformers are talking about – not the bizarre, phony “death panels” falsely conjured by Newt Gingrich, Sarah Palin, Betsy McCaughey and others, now including Iowa Republican Senator Chuck Grassley – would have been welcome.

    Continue reading "Michael Winship: The Gorilla Dust of Health Care" »

    July 31, 2009

    Assessing a "Public Option" for Health Care

    (Photos by Robin Holland)

    This week on the JOURNAL, Bill Moyers spoke with Wendell Potter, a former health insurance executive who left the industry to become an advocate for health care reform. Potter discussed the industry’s history of denying care to members and its extensive efforts to prevent the federal government from creating a “public option” for health insurance to compete with private plans. Potter said:

    “The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that you're heading down the slippery slope towards socialism... I think that people who are strong advocates of our health care system remaining as it is, very much a free market health care system, fail to realize that we're really talking about human beings here, and it doesn't work as well as they would like it to... They are trying to make you worry and fear a government bureaucrat being between you and your doctor. What you have now is a corporate bureaucrat between you and your doctor... The public plan would do a lot to keep [health insurance companies] honest, because it would have to offer a standard benefit plan. It would have to operate more efficiently, as does the Medicare program. It would be structured, I’m certain, on a level playing field so that it wouldn’t [have an] unfair advantage [over] the private insurance companies. Because it could be administered more efficiently, the private insurers would have to operate more efficiently.”

    The “public option” is central to many Democrats’ vision for health care reform, but it has attracted pointed criticism from supporters of the “single payer” model and opponents of federal intervention alike.

    In an edition of the JOURNAL broadcast in May, Dr. Sidney Wolfe of the public interest group Public Citizen advocated for “single payer” health reform, in which a single government agency would replace and eliminate private health insurance. Wolfe told Moyers that previous experiments with the “public option” have failed:

    “In seven states, ranging from Washington to Minnesota to Maine, they have tried what amounts to a mixture of a private and a public plan. And in none of the states has there been any sustained reduction in the number of uninsured. It's way too expensive. As long as you have private plans in there, everybody still has to do all the bookkeeping and everything. So, it has failed. As Einstein said, ‘The definition of insanity is doing something over and over again, and expecting to have a different result.’ We've seen the same unsatisfactory, unacceptable result, in state after state after state after state after state, why mess up the whole country with it?”

    Recently, policy analyst Anthony Randazzo of the Reason Foundation, a libertarian group, argued that the “public option is an economic nightmare.” He wrote:

    “If [the public option] is working then I will want to be part of it. And so will everyone else... Suddenly the public option starts pulling people away from private companies. Those companies will need to charge more for their decreased number of clients... In the meantime the public option will be overrun, and be maxed beyond its capacity... [President Obama said] that the government is not capable of running all health care in this economy, which is why his public option isn’t trying to take people from the private system. Ultimately, from an economic perspective, either the public option works and draws in lots of people until it can’t anymore, or it doesn’t work and is an economic mess. Either way, it’s not pretty.”

    What do you think?

  • Do you agree with Wendell Potter’s view that the health insurance industry’s pursuit of profit has hurt patients? Why or why not?

  • Do you support a “public option” for health insurance to compete with private plans? If so, are you concerned about the objections raised by Wolfe and/or Randazzo?

  • July 24, 2009

    Diagnosing Proposals for Healthcare Reform

    (Photos by Robin Holland)

    This week on the JOURNAL, Bill Moyers spoke with two leading healthcare journalists, Trudy Lieberman and Marcia Angell, M.D., seeking their perspectives on the current health reform debate in Washington. Lieberman and Angell each addressed whether the “public option” proposed by President Obama would actually serve to insure all Americans and who in the private health industry stands to benefit from the reforms under discussion.

    Trudy Lieberman said that Obama’s proposed “public option,” in which the federal government would set up its own insurance option to compete with private insurance plans, has not been explained in detail and would likely not be effective in containing costs:

    “From my vantage point, I don't see that the solutions for controlling costs, that will really control costs the way other countries do, are really in place... We hear about preventive care as saving costs, because intuitively it sounds like it's going to work, but the academic studies show that more preventive care actually raises costs. That doesn't mean it's a bad thing to do, but it's not a good cost saver in the system... [Obama] has been vague right from the very beginning, we have not known exactly what the Obama health plan has been... I see an administration that is trying to keep this playbook going as long as possible, and to commit to as little as possible until the eleventh hour. By then, it’s going to be too late for the American people to know what’s going to await them... As a journalist, that troubles me.”

    Marcia Angell argued that the “public option” would not create the change needed in the American healthcare system and that reformers should advocate for a “single payer” system, in which a single federal agency would replace and eliminate the private health insurance industry:

    “What [Obama] has essentially advocated is throwing more money into the current system. He's treating the symptom and he's not treating the underlying cause of our problem. Our problem is that we spend two and a half times as much per person on health care as the average of other advanced countries, and we don't get our money's worth. So now he says, ‘Okay, this is a terribly inefficient, wasteful system. Let's throw some money into it...’ Obama said in his press conference [that] the worst thing we can do is nothing, the most costly thing we can do is nothing. I disagree with that – you can throw more money into this system and make it even more costly... I think we have to start all over on this, I really do. I think we have to go for a single payer system.”

    In his recent appearance on the JOURNAL, Clinton administration Secretary of Labor Robert Reich agreed that “single payer” is the best idea, but said that it is politically impossible and that the “public option” should be enacted anyway:

    “[The public option] means that average members of the public have a choice, if they want it, of either their private-for-profit insurers like they now use or a public not-for-profit insurer. That public insurer would resemble ideally Medicare, [with] low administrative costs and it would have the economies of scale. It would be so large that it could actually negotiate low drug prices and very low premiums. That’s what the private insurers are scared of, because that means that their profits will be squeezed... Unless they are going to be genuinely pressured to reform through a public option, there is nothing that’s going to change them... The single payer system would be the best of all... Unfortunately, we can’t get there from here because the political forces are just too strong against single payer.”

    What do you think?

  • If instituted, do you think President Obama’s proposed “public option” for health insurance would be sustainable? Why or why not?

  • Is flawed health reform legislation better than nothing or, as Marcia Angell argues, even worse? Should we start over? Explain.

  • Bill Moyers & Michael Winship: Obama's Health Care Struggle – Waterloo or Water Down?

    Push finally came to shove in Washington this week as the battle for health care escalated from scattered sniper fire into all-out combat. If it all seems to be getting more and more confusing, join the club. It’s hard to see what’s happening through all the gun smoke.

    The Republicans have more than health care reform in their bombsights – they want a loss for Obama so crushing it will bring the administration to its knees and restore GOP control of Congress after next year’s elections. In the words of Republican Senator Jim DeMint, “If we’re able to stop Obama on this, it will be his Waterloo. It will break him.”

    The “Waterloo” of DeMint’s metaphor, of course, is not the 1974 ABBA hit but the battle in 1815 that ended Napoleon Bonaparte’s rule as Emperor of France – a humiliating defeat and a turning point in European history. Right wingers like Glenn Beck see Obama as Napoleon incarnate, a popular emperor who must be stopped.

    Here’s what Beck said on his television show Monday, July 20: “I’m telling you, this guy is dangerous. He’s never lost before. He won’t understand… like, ‘Who are you to question me?’ I mean, this guy is practically an imperial President now. When he starts to lose and people start to question him and push him back against the wall, he’s not gonna know how to react.”

    The Republican strategy is almost identical to the way they turned health care into Waterloo for Bill and Hillary Clinton in 1993. Back then, one of their chief propagandists, William Kristol, urged his party to block any health care plan for fear that Democrats would be seen as “the generous protector of middle class interests.” Now he’s telling the GOP to “go for the kill… throw the kitchen sink… drive a stake through its heart… We need to start over.”

    Continue reading "Bill Moyers & Michael Winship: Obama's Health Care Struggle – Waterloo or Water Down? " »

    May 21, 2009

    Single-Payer: Is Nationalized Health Coverage the Way to Go?

    (Photos by Robin Holland)

    This week, the JOURNAL examined the political and logistical feasibility of single-payer universal health insurance, which has broad public support but has been conspicuously absent from the health care debate in Washington and the mainstream media.

    Bill Moyers asked Dr. David Himmelstein, co-founder of Physicians for a National Health Program, to explain what single-payer means. He said:

    “It’s what we used to call national health insurance, so government collects the money for health care from taxes. You don’t pay premiums – instead, you pay taxes, [which] pays all the bills. Hospitals remain privately owned and operated. Doctors remain mostly in private practice. But their bills go to the government insurance program, just as they do today with Medicare, but we’d be able to streamline the payment system if we had only one payer instead of Medicare being one among many. So a hospital would get paid like a fire department does today: you have one check a month that pays for the entire operation, and that means you can eliminate the huge billing apparatus of the hospitals and the doctors’ offices where we’re employing many people to do our billing.”

    Advocate Donna Smith told Moyers why she supports single-payer universal health insurance over the present system or the public-private hybrid model proposed by the Obama administration:

    “It’s a great idea from the left, which is public financing, combined with a great idea from the right, which is private delivery. And you put it together in one system that takes out the waste and the abuse that’s really happening, which is where all the money really goes in health insurance. Up to 30 percent of the costs have nothing to do with healthcare at all and everything to do with fueling the health insurance needs... We've got to have a national health program, we just have to do it. It's the only way we fix this mess. It's spun out of control, it's gonna bury us financially, it's gonna mortgage our children, and it kills people.”

    Some are skeptical that the federal government is capable of responsibly running a national health insurance program. In the WALL STREET JOURNAL, columnist John Steele Gordon wrote:

    “It might be a good idea to look at the government’s track record in running economic enterprises. It is terrible... Other than the source of its premiums, Medicare is no different, economically, than a regular health insurance company. But unlike, say, UnitedHealthcare, it is a bureaucracy-beclotted nightmare, riven with waste and fraud... Because of the need to be re-elected, politicians are always likely to have a short-term bias. What looks good now is more important to politicians than long-term consequences even when those consequences can be easily foreseen... And politicians tend to favor parochial interests over sound economic sense... The inescapable fact is that only the profit motive and competition keep enterprises lean, efficient, innovative and customer-oriented.”

    What do you think?

  • Should the U.S. pursue single-payer universal health coverage? Why or why not?

  • Is single-payer universal health insurance politically feasible? Explain.

  • Are there any alternative models for health care that are being left out of the discussion or that you support?

  • POLL: Do You Support the Obama Administration’s Health Coverage Proposal?

    (Photo by Robin Holland)

    In the JOURNAL’s exploration of health care this week, Bill Moyers’ guests were critical of the Obama administration’s health care strategy, which Reuters summarized as follows:

    “Obama urged Congress to make sure any healthcare reform bill lowered costs, let Americans choose their own doctor and health plan and ensured quality, affordable care for everyone... Obama's proposal would establish a new government health insurance plan to compete with private insurers and cover the uninsured, but many Republicans and insurers argue that would undermine the private healthcare market.”

    Single-payer advocate Dr. Sidney Wolfe of the nonpartisan public interest group PUBLIC CITIZEN told Bill Moyers that plans similar to what Obama is proposing have failed on the state level:

    “In seven states, ranging from Washington to Minnesota to Maine, they have tried what amounts to a mixture of a private and a public plan. And in none of the states has there been any sustained reduction in the number of uninsured. It's way too expensive. As long as you have private plans in there, everybody still has to do all the bookkeeping and everything. So, it has failed. As Einstein said, ‘The definition of insanity is doing something over and over again, and expecting to have a different result.’ We've seen the same unsatisfactory, unacceptable result, in state after state after state after state after state, why mess up the whole country with it?”

    We invite you to take our poll and share your thoughts in the space below.

    March 20, 2009

    The Cycle of Abuse

    (Photo by Robin Holland)

    In this week's JOURNAL, Bill Moyers spoke with Marta B. Pelaez, who runs an agency for women and children who have been victimized by domestic abuse. Moyers asked Pelaez why so many women go back repeatedly to partners that have injured them physically and emotionally.

    Pelaez said:

    “At the beginning, they don't see very well the level of trauma that they have sustained, and that has been progressive, over a lifetime, in many instances... We are, as human beings, beings of custom. We are accustomed to something. We have made some adjustments to adjust to a certain situation, as awful and as ugly as that may be. So it is difficult for them... If you stay in an abusive situation one year, the likelihood of your staying a second year grows exponentially... Why? Because the progressive nature of domestic violence is one that begins in a very subtle way... It's about isolating the person from the relatives, from friends, so that he can exercise more and more abuse. And then, eventually, it becomes the physical thing. It becomes the dramatic thing that we see on the newspapers. But in order to get to that point, the abuse has been going on for a long time."

    What do you think?

  • Does Pelaez’s explanation correspond with your own experiences and/or observations of domestic abuse? How?

  • Pelaez describes a progression of more and more dehumanization over time. Is this dynamic applicable to situations other than domestic abuse, such as business or politics? Explain.

    For more information, please visit our resources page on domestic violence.

  • November 26, 2008

    Do Healthy Options Lead To Healthy Decisions?

    (Photo by Robin Holland)

    This week on the JOURNAL, Bill Moyers spoke with author Michael Pollan about America’s problematic food policies and what citizens might do for their –- and the nation’s –- health. Pollan said:

    “I'm not a puritan about food and I'm not a zealot about it, and there is something called special occasion food that we have in our house. And it's kind of understood that sometimes you go enjoy your fast food, you have your Twinkie, whatever it is. People have done this for thousands of years. There's nothing wrong with doing it. Our problem is we've made special occasion food [into] everyday food and that one in three children are at a fast food outlet every single day... One of the reasons that people in the inner city have such higher rates of diabetes [is that] there is a demand for fresh and healthier food that’s not being served.”

    Arguing that nutritious options were too difficult to find, the Los Angeles City Council earlier this year passed a moratorium on any new fast food restaurants in a number of poor neighborhoods with disproportionate rates of diabetes and obesity. Beyond the expected complaints of restaurant chains, the public response was mixed; journalists noted that healthy fare was already easily available from fast food franchises and the area’s three underutilized farmers’ markets, while many community members were skeptical that the ban would prove effective:

    “‘[The ban is] stupid. It’s our body, we choose what we put in it,’ Tonya Owens, a 45-year-old nurse assistant, told Reuters... ‘It’s fast and easy. I think people will still come here no matter what,’ [Edwin] Tsai, 23, said."

    What do you think?

  • Given nutritious options, will most people make healthy eating decisions? Why or why not?

  • What policies do you propose to improve America’s health? Do you believe that your ideas are politically and logistically feasible?

  • June 3, 2008

    Exposé Reporters Answer Your Questions

    We thank reporters Cary Spivak, Susanne Rust and Meg Kissinger for taking time to answer your questions about Exposé's story on their work following the chemical Bisphenol A.

    Please note that the views and opinions expressed by the reporters are not necessarily the views and opinions held by Bill Moyers or BILL MOYERS JOURNAL.

    I would very much like to know what is happening in the European Union regarding Bisphenol A. Is the EU addressing the safety of BPA? Thank you so much.

    The European Union's food safety watchdog, the European Food Safety Authority (EFSA), may review the chemical Bisphenol A, the agency website says.
    "EFSA is aware of the studies on bisphenol published in the United States and Canada. The agency will examine whether it should review its opinion on this product, which dates from January 2007," spokeswoman Anne-Laure Gassin said.

    Bravo! Wonderful reporting. Can you please tell me which plastics contain the toxic substances? Are they marked in any way, i.e. by the number in the triangle on the bottom? Many thanks to you for such a wonderful expose.

    Plastic containers with the recycling number 7 often contain polycarbonate, which contains Bisphenol A. You should know that not all plastic containers have recycling labels on them, including baby bottles and sippy cups. Those with the no. 3 on them are made of polyvinyl chloride which may contain Bisphenol A as well as phthalates, another kind of endocrine disruptor.

    In your opinion, if the government does decide to act and announces that Bisphenol A poses enough of a risk to ban it from products such as water bottles an the linings of metal cans, what will the fall-out or repercussions be? Will the millions(?) of products inflate in cost along with the regular inflating? Will we see certain products being recalled? What other chemicals are we being exposed to that could cause great health risks that the government has ignored due to corporate manipulation and interests?

    Several companies are removing bisphenol A from their products or merchandise, including Nalgene, Wal-Mart and Toys R Us. Many are working to develop alternatives to Bisphenol A. We'll be watching to see what the effects on the marketplace will be.
    There still are many chemicals in use that scientists are suspicious of and others that are known to be dangerous that remain in the marketplace.

    Do you think that there will be more reporters like yourselves -- with specialized science backgrounds? Does the consumer's ability to access more and more information hampering or helping beat journalism?

    There probably will be more reporters with specialized backgrounds in science -- also law, education, the arts, etc. It's a really interesting question to wonder if more information by consumers hampers or helps beat reporters. It probably helps. The more consumers know, the better their questions will be. They will be pushing us to ask more and tougher questions.

    The report says that from 1996 to 2007 --- a period that had both parties in the White House --- the EPA hadn't screened a single chemical. Are both parties compromised by the chemical lobby's influence?

    We will let the educated viewers of PBS figure that out.

    What was the $80 million for endocrine research actually spent on, if not chemical testing?

    The $80 million went for "payroll and program support" to develop the screening program, according to the EPA spokespeople. They had a lot of meetings to discuss how to screen these chemicals. They went through no fewer than three different permutations of the program.

    It's always heartening to see good, relevant journalism. Thank you. How does one determine what plastic items contain Bisphenol A? Can it be purged from the body once ingested?

    Look for recycling no. 7 -- and generally any hard, non-disposable clear plastic is likely to contain Bisphenol A. Children and adults break down Bisphenol A pretty quickly. But there is nearly constant exposure. So, the body gets inundated. Research shows that very young babies and fetuses may not be able to break it down because they lack an enzyme that allows them to do so.

    May 16, 2008

    Do Pharmaceutical Commercials Benefit Americans?

    (Photo by Robin Holland)

    On this week’s JOURNAL, Bill Moyers spoke with Melody Petersen, an independent journalist who formerly covered the drug industry for the NEW YORK TIMES and is author of OUR DAILY MEDS: HOW THE PHARMACEUTICAL COMPANIES TRANSFORMED THEMSELVES INTO SLICK MARKETING MACHINES AND HOOKED THE NATION ON PRESCRIPTION DRUGS.

    Addressing how advertising and marketing have affected the prescription drug business, Petersen said:

    “A very powerful technique that the drug companies spend millions and millions of dollars on is hiring physicians to give lectures to other physicians on their drugs. It looks like the physician is up there giving his independent position on this drug, but often he’s been trained by an advertising agency. His slide presentation has been created by an ad agency. It looks like independent science, but it’s not... They want to get as many articles published in our medical journals as they can that show their products in favorable lights and will get physicians to prescribe them, so they often hire a Madison Avenue ad agency to write up an article for them or a study. The name of the ad agency rarely appears in the published version; instead, they hire doctors to put their names on as author... It’s gone so far that some independent scientists are starting to view our medical literature as propaganda.”

    Others, including the U.S. Food and Drug Administration (FDA), argue that “direct to consumer” ads help educate and engage prospective patients about their healthcare options.

    What do you think?

    A Companion Blog to Bill Moyers Journal

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