This Week: Health Care as Commodity


This issue of the Notes is full of details, but it’s really all about Individualism.  The point is to pay attention to the events and propaganda that create the conditions for the headlines we see, and try to focus a little less on the specific individual in the headlines.  Headlines get us thinking about heros and villains, when we should be thinking about patterns and systems.  That’s what this issue is meant to illuminate.

This week marks the 44th anniversary of my being a vegetarian.  It’s probably about time that I write up my ecological, economic, ethical, financial, and health reasons for sticking with this lifestyle for as long as I have.  Maybe you’ll see it in these pages before long.

OK, that’s all I have room for right now.  See ya next time,


“Quote” of the Week: Prejudice, Racism, White Supremacy


This is from an article in the Summer 2008 edition of the Journal of Counseling & Development.  It’s called “Prejudice and Racism, Year 2008—Still Going Strong.”

“Prejudice has been defined as negative bias toward a particular group of people.  The core of racism essentially includes a prejudiced sense of superiority in an in-group with a concomitant exercise of power to subjugate an out-group. Thus, whereas prejudice is mainly attitudinal in nature, racism extends the negative attitude into behavior that discriminates against a particular group.

“White supremacy [is] a system of power and domination, determined consciously or subconsciously, and embedded in the logic, thought, speech, action, perceptions, and affective response of people who classify themselves as White.”

The full article is a little difficult to find.  If you would like a copy, email me and I’ll send you one.

Searching for A Better Way for Health Care


The front page of the June 22nd New York Times was consumed with the details of the race for the White House, specifically the struggles of the would-be Republican candidate.  The headline was “Money Lagging, Trump Suggests He’ll Fund Race,” and it was filled with the usual blah-blah-blah about fundraising and campaign tactics and so on and so forth.


Meanwhile, on page 11 of that day’s Times, there was a hugely-important story about the Republican plan to reform the entire health care system in the United States, as presented by Paul Ryan, the charismatic Republican Speaker of the House.  The British news agency Reuters tells us that “The proposal is part of Ryan’s blueprint, titled ‘A Better Way,’ which offers a Republican alternative to the Democratic Party on policy issues ahead of the Nov. 8 election.”  Adds the right-wing libertarian magazine Forbes, “it’s a 37-page white paper which describes, in a fair amount of detail, a kind of ‘conversation starter’ that House GOP leadership hopes to have with its rank-and-file members, and with the public, in order to consolidate support around a more market-based approach to health reform.”  If the proposal is adopted, says Forbes, “all in all, we would have a far better health care system with the Ryan plan than we do today.”


Having a better health care system is something that nearly everyone wants, no doubt.  But if progressive forces were able to “consolidate support” around a more social and cooperative approach to health reform, then widespread discontent with the current system could lead us towards a public health system that sees health care as a human right.  Preventing that from happening is the larger goal of this “conversation starter” called A Better Way, which is an ideological document above all else.

Building support for the “market-based approach” to health care has long been a key strategy of the Right in this country, and will continue to be so after November 8th, regardless of who is elected President.  So it’s worthwhile to spend a moment understanding what these Big Thinkers have in mind for the future of the health care “system” in the United States.

“A Better Way” for Health Care

It may surprise some to hear me say that this position paper on “A Better Way” for health care is really not about health care.  For example, the third principle upon which the document is based—“Protect Our Nation’s Most Vulnerable”—says that “vulnerable Americans should have access to high-quality and affordable coverage options.”  Note that the goal is coverage, not health care.  That’s a market orientation talking.  Dr. Alex Benos of Greece, at a recent conference, said it plainly: “Health and health care are not commodities that exist to drive the economy. They are among the social goals which we have an economy to achieve.”  That idea apparently does not sound bizarre in many parts of the world.  But to someone educated in the USA, it’s largely incomprehensible.  A social approach versus a market approach.  Imagine that.

Changing the public discussion, and in the process changing USAmericans’ deep thinking about health and other aspects of our social welfare, is what Paul Ryan and many other reactionary thinkers are up to.  (Brief digression here on Donald Trump: He does not think this way, which is largely why the Republican intelligentsia are so freaked out at the moment.  While Trump is not a Democrat, he does not share The Vision being promoted by the Right’s Big Thinkers.  At least, as far as anybody can tell.  TrumpCare?  Imagine that.)

The first thing on the “A Better Way” agenda, as expected, is to repeal Obamacare.  No surprise there.  Despite it being one of the most business-friendly pieces of legislation I can remember (Business Insider headline: “Obamacare has been great to Wall Street”), the so-called right-wing hates it.

So, what does this “conversation starter” actually contain in terms of policy recommendations?

“Successful Health Reforms”

Early on, “A Better Way” states that “In the 21st century, Congress has enacted four major successful health reforms: 1. Health Savings Accounts (HSAs) and consumer-directed health care; 2. Medicare Advantage; 3. Medicare Part D prescription drug coverage, and 4. Quality reporting and paying for value.  These ideas, which began as Republican proposals, now enjoy wide bipartisan support and are more popular than ever.”

Let’s just take the first one: Health Savings Accounts.  This is the idea that people with high-deductible health insurance plans can set aside money, tax free, that they can use to pay for the cost of the care that is not covered due to the high deductible.  There are many problems with HSAs, but I’ll focus here on the racist effects of this approach.  A Families USA study from 2008—“An Unequal Burden: The True Cost of High-Deductible Health Plans for Communities of Color”—makes some of the key points.

* “Racial and ethnic minorities are less likely to have the extra income to deposit into an HSA, and they are likely to receive less in the way of tax benefits from HSAs compared to whites.”

* “High-deductible plans with health savings accounts will shift costs onto sicker Americans.”  Then, consider that “Racial and ethnic minorities report being in poorer health than whites, and they also face greater burdens from several chronic illnesses.”  As healthier, wealthier people flee the more expensive plans in favor of cheaper, high-deductible plans, rates for those who remain will go up.  Thus, Families USA points out, those higher rates “will disproportionately hurt sicker people, including racial and ethnic minorities.”

* The myth promoted by advocates of HSAs is that “Most people with high-deductible health plans have set aside enough money to pay their medical expenses.”  Families USA points out that “many people with such plans do not actually have enough money to set aside savings for their medical care and are thus at financial risk. Survey data show that most workers with high-deductible plans have not actually opened HSAs.”  The Working Poor Families Project reminds us that “In 2013, working families headed by racial/ethnic minorities were twice as likely to be poor or low-income compared with non-Hispanic whites.”


I’ve written on several occasions about Paul Ryan and his earlier attempts to cut Medicaid and Medicare.  Sure enough, “A Better Way” also proposes to end Medicaid and Medicare as we know them.  Of course Mr. Ryan doesn’t say “end.”  He says “reform.”  But when he says that “today’s Medicaid program is unsustainable,” the message is clear, and in fact his proposal is more or less what he’s proposed before.

Currently Medicaid—which provides health care to low-income people of any age—is a program in which federal funds flow to states based on actual costs and needs as economic circumstances change.  Ryan proposes changing it into a system of “per capita allotments” or “block grants,” which would give states a set amount of money which, when it runs out, will leave people high and dry.  In other words, it would change Medicaid from a “safety net” program into a “wish and hope” program.  That is, poor folks could only wish and hope that the money doesn’t run out before they have a medical emergency.  Or need any medical care, emergency or not.

In addition, traditional Medicaid is what is known as a “counter-cyclical” program.  That is, it provides assistance to more low-income households during an economic downturn or recession and to fewer households during an economic expansion.  This not only provides more help when more help is needed, it also has a stimulus effect, as it pumps money into the economy at times when people have less money to spend.  A counter-cyclical program helps on the micro-economic level by helping individuals get their needs met.  And they have macro-economic benefits due to the stimulus effect.  “A Better Way” would change all that.


The Kaiser Family Foundation says that “‘A Better Way’ includes virtually every idea on health care proposed by Republicans going back at least two decades.”  And nowhere is that more evident than in the section called “Protecting and Preserving Medicare.”  Translation: “Dismantling and Destroying Medicare.”  (Medicare is different from Medicaid, as it provides health care to people over 65 and some people with disabilities.)

After listing a hodge-podge of proposals too wonky or meaningless to go into here, “A Better Way” states that “The final step to save the program is transforming the benefit into a fully competitive market-based model—known as premium support.”  That’s followed by the statement “This is not a voucher program.”  Translation: It is a voucher program.

The Kaiser Family Foundation says, “It’s not surprising that Republicans favor the term premium support, as the word voucher elicits a strong negative reaction from the public.”  But they’re essentially the same thing.  Kaiser quotes the president of a conservative think tank, John Goodman, saying “I use the words interchangeably.  It just means that the government limits the amount of money that it puts up, and people have to add to it if market prices are higher.”

Medicare is massively popular with the public.  According to the National Committee to Preserve Social Security and Medicare, “Perhaps one of the biggest reasons why Medicare is universally cherished is that, in return for the contributions we make during our working years, we receive guaranteed health benefits.”  And the end of that guarantee is at the heart of the “reforms” proposed in A Better Way.

Beyond Voting

Orienting the conventional wisdom on health care away from the idea of health as a social goal and towards the idea of health as a commodity is the larger goal—the “metacommication,” if you will—of “A Better Way.”

“A Better Way” assumes a commodified system in which corporations offer whatever options they want and people get to “choose” from among them.  People with more money have more choices.  That’s how markets work.

This is not, fundamentally, about Democrats and Republicans.  It’s about changing the consciousness of the great mass of people in the United States, away from a social and cooperative approach to the nation’s problems and towards a “market-based” approach, which is based on individualism and competition.  And it’s not just an approach to the nation’s problems, it’s a way of living.

That’s why, while voting is important, far more important is what we do before and after an election.  Because whoever the next President may be, the struggle is going to be what it has been forever: Will we organize our future based on “dog-eat-dog” or “one for all and all for one”?  Which one is “A Better Way”?  It won’t be settled on November 8th.

“Social Security Expansion Really Could Happen”

The previous article highlighted the efforts of regressive forces to change the thinking of USAmericans, turning them away from a social understanding of health and towards an individualistic and competitive way of thinking.  But it works the other way, too, as a recent article by Reuters correspondent Mark Miller makes clear.

The June 12th Star Tribune of Minneapolis picked up the Reuters story and ran it with the headline “Benefits See a Political Shift.”  The lead paragraph says “A coalition of progressive politicians, policy experts and grassroots advocates started a campaign three years ago facing very long odds. They proposed expanding Social Security retirement benefits for millions of Americans.”

Miller notes the reasons for such a proposal, saying “it has become more evident that retirement security is eroding for many Americans… the share of households receiving guaranteed income from traditional pensions has plunged…” and “a very large segment of the near-retirement community has negligible savings.”  That includes “33 percent [who] have saved less than $25,000.”

Despite those facts, Miller reminds us that “Mainstream thinking in Washington [three years ago] ran in the opposite direction: Social Security benefits should be cut as part of a ‘grand bargain’ to get the federal deficit under control.”  I cheered at the time progressive efforts beat back that effort to cut Social Security (See Nygaard Notes #552: The Grand Bargain is Dead!”).  The news has gotten even better since then.

Noting that it’s only been three years since “mainstream thinking” had put Social Security on the chopping block, Miller tells us that “the tide has turned—big time—and it is starting to look like Social Security expansion really could happen.”

Miller gives a lot of the credit for this shift to powerful figures like Senators Bernie Sanders, Elizabeth Warren, Sherrod Brown and Tom Harkin.  But he really had it right in his first paragraph.  It was “a coalition of progressive politicians, policy experts and grassroots advocates”, working together for years all over the country, that turned the tide.

And they’ve been working for a lot longer than three years. Uncounted numbers of individuals and organizations have been organizing since the mid-1990s to protect and expand Social Security.  Without those people and organizations, we would have no proposals from Bernie Sanders to expand the program.  Yes, expanding Social Security “really could happen,” and the credit goes to the grassroots.  What YOU do is important.  Always remember that.