By Judy Keen, USA TODAY
CHICAGO — Raudel Sanchez's American dream was so strong that he tied a few possessions around his waist in 1967 and swam across the Rio Grande into Texas.
"I wanted to make a better life in America," says Sanchez, 63. "My dream was bringing my family here and working together."
Sanchez, now a U.S. citizen, joined a brother in Chicago after crossing the border near Laredo, Texas. He worked as a butcher, making $1.85 an hour, and took a second job at a candy factory. He often worked 14 hours a day. He saved his earnings and eventually brought his wife, siblings and parents — who are now in their 90s — to Chicago.
Eventually, he opened several small businesses and built a comfortable life for himself and his family. But now, the recession has hit him hard. He has sold one of his three clothing stores and a restaurant, resulting in layoffs of several immigrant workers. He's considering selling a second store.
Sanchez's story reflects how immigrant-owned businesses — a key part of the U.S. economy — are being threatened by the recession. About 1.5 million immigrants own U.S. businesses, according to a study for the Small Business Administration by Rob Fairlie, an economics professor at the University of California-Santa Cruz. He found that immigrants are 30% more likely to start a business than non-immigrants. They account for 11.6% of all U.S. business income.
Many immigrants started with nothing and built businesses that support them and their extended families and communities.
They epitomize the American dream: Work hard and you can build a good life.
With customers spending less and banks less willing to loan money, some immigrant entrepreneurs are wondering whether that's still true.
A few years after arriving here, Sanchez bought a foreclosed house, then three more. He sold two of them in 1985 and used the money to open Sanchez Bros. Western Wear, a clothing store. He expanded to two more stores in the suburbs, bought a restaurant and started a record label for Mexican music.
He tried to run his businesses cautiously: He paid cash for merchandise and didn't use his line of credit at the bank. When people stopped buying $1,000 cowboy boots, he stocked $400 pairs.
Now they aren't selling, even on sale. "Every year we've seen a decline" in sales, he says.
Besides selling two of his businesses, Sanchez has stopped advertising. He laid off most employees, and now family members are behind the counters.
The record label is down to its last two acts. "I had a meeting with my family and told them we've got to work more and more hard," he says.
Sanchez believes his seven children and nine grandchildren will build successful lives here. He's sure the economy will rebound.
"Maybe next year," he says. Still, he's wondering about his future at a time when he should be planning retirement.
"I still believe in this dream I had many years ago," he says. "The only thing is, you have to work hard."
'We just couldn't hang on'
Niall Freyne's dream was snatched away by the recession.
Freyne, an Irish immigrant, closed Galway Tribes Irish Pub last month after lunch and weeknight business dwindled along with his customers' confidence in the economy.
"We just couldn't hang on," says Freyne, 43, who opened the restaurant in 2005 in suburban Frankfort, Ill."We've already lost so much: all of our life savings, all of the equity in our home."
Freyne wrote a letter to President Obama asking why small businesses like his can't get a federal bailout — he says he got no reply — and he held out hope until the last minute that some generous millionaire would rescue him. That didn't happen either, and now Freyne isn't sure how he'll support his wife, Dorothy, and son James, who is 6, or what will become of his 42 employees.
"I feel like I've let everybody down," he says. "I can't control the economy, and that's what killed me."
People who leave their countries to pursue success in the USA often are risk-takers who are optimistic and willing to work especially hard to build successful futures for their children and grandchildren, says Allert Brown-Gort, associate director of the Institute for Latino Studies at the University of Notre Dame.
In difficult economic times, "immigrants are much more likely to battle it out for longer," he says, in part because they realize that "success or failure is really on them, and this is going to have an effect for generations to come."
Because immigrant business owners — particularly those who operate stores or restaurants — often depend on their own communities, they can be "more vulnerable in these downturns," says Gregory DeFreitas, an economist at Hofstra University.
For the same reason, recovery will come more slowly to immigrant businesses, he says.
Entire family invested
Susan Patel inherited her American dream from her father, Tulsi, and uncle Mafat, immigrants from India who founded Patel Brothers, a national chain of 41 Indian grocery stores.
Last year, Susan Patel bought Patel Brothers Handicrafts & Utensils, a small Chicago shop that sells kitchen items and Hindu statues and temples, from her father. Since then, she has watched several of the Indian and Pakistani businesses that line Devon Avenue close and stopped paying herself a salary to avoid laying off her two employees.
"We've all had to adjust," says Patel, 33, but she's confident she can survive the recession. She feels obliged to keep her store open to help the neighborhood get through the recession. "If I close, customers may not come to this area at all," she says.
Patel's uncle came here from Bhandu, a rural Indian village, in the late 1960s. Her parents, Tulsi and Aruna, followed in 1971. Everyone shared a house, and Patel's parents worked in factories.
"They saved their money so they could have the American dream," she says. In 1974, they bought a small grocery. More relatives emigrated from India to join the growing throng in the Patel home, Patel says, and more stores and a line of Indian food followed. The family bought restaurants, travel agencies and real-estate companies, and the two brothers' children work in them.
Patel believes immigrant-owned businesses are more likely to make it through the recession because owners often invest their life savings — and their lives — in them. "Everyone works all the time," she says. "At the dinner table, all we talked about was business. It's all we knew."
Patel's goals are identical to those that led her parents to risk everything and come here: "just to make it, to be a success."
Confident in the economy
It will take more than a recession to threaten the dreams of many immigrant business owners who left their homelands because of political turmoil.
Christos Koskiniotis, 46, and his mother, Panayiota Koskiniotis, 67, own Four Seasons Cleaners. They came here in the 1970s from Greece after government coups forced his late father to close the cafes he owned.
The dry-cleaning business is stable for now, Christos Koskiniotis says. His mom is unfazed because she's "seen everything in her life," he says.
Their confidence in their plan for a better life in the USA is unwavering. "For the long term, this is the best place to be," he says. "You're going to hit rough spots no matter where you're at. … I don't think the American dream is ever going to die. To think that would be like giving up on hope."
Dana Kapacinskas, 48, moved here from Kounas, Lithuania, in 1979, during the country's occupation by the Soviet Union. The dream that propelled her family was simple: "Freedom. At that time in the Soviet Union, you couldn't move, you couldn't go anywhere. They would follow you," she says.
The family started a bakery/deli here that grew over time. Racine Bakery now has more than 25 employees and distributes its baked goods to area supermarkets. Business hasn't been affected much by the recession, Kapacinskas says, "maybe because it's comfort food. … People still have to eat."
Things are going well enough that the bakery donates food to area churches, schools and non-profit groups. Kapacinskas says she, her parents and brother were motivated to improve their lives and demonstrate to people in their new country that they were willing to work hard.
"I was very eager and I had good work ethic and I saw the opportunities," she says. "We left our friends and missed our family, but the freedom and the opportunities were unlimited."
That's what Freyne thought, too. He opened Galway Tribes after working at hotels and restaurants in Ireland and the USA. He bought the land and built the place, furnishing it with items imported from Ireland.
"We were making it. We were fine, and then about a year ago the economy started going down a bit and people stopped coming out during the week," Freyne says. Then a new assessment a few months ago pushed his property taxes beyond what he could afford. "We just couldn't survive on weekends alone," he says.
Freyne wants to believe that his American dream can somehow be revived when the economy improves.
"You can't know when that will happen," he says. "I put my blood, sweat and tears in this place. It's a sad story."
Monday, June 15, 2009
Text: Obama’s Speech on Health Care Reform
Following is a text of President Obama's prepared address on health care reform to the American Medical Association, as released by the White House.
From the moment I took office as President, the central challenge we have confronted as a nation has been the need to lift ourselves out of the worst recession since World War II. In recent months, we have taken a series of extraordinary steps, not just to repair the immediate damage to our economy, but to build a new foundation for lasting and sustained growth. We are creating new jobs. We are unfreezing our credit markets. And we are stemming the loss of homes and the decline of home values.
But even as we have made progress, we know that the road to prosperity remains long and difficult. We also know that one essential step on our journey is to control the spiraling cost of health care in America.
Today, we are spending over $2 trillion a year on health care – almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren't any healthier. In fact, citizens in some countries that spend less than we do are actually living longer than we do.
Make no mistake: the cost of our health care is a threat to our economy. It is an escalating burden on our families and businesses. It is a ticking time-bomb for the federal budget. And it is unsustainable for the United States of America.
It is unsustainable for Americans like Laura Klitzka, a young mother I met in Wisconsin last week, who has learned that the breast cancer she thought she'd beaten had spread to her bones; who is now being forced to spend time worrying about how to cover the $50,000 in medical debts she has already accumulated, when all she wants to do is spend time with her two children and focus on getting well. These are not worries a woman like Laura should have to face in a nation as wealthy as ours.
Stories like Laura's are being told by women and men all across this country – by families who have seen out-of-pocket costs soar, and premiums double over the last decade at a rate three times faster than wages. This is forcing Americans of all ages to go without the checkups or prescriptions they need. It's creating a situation where a single illness can wipe out a lifetime of savings.
Our costly health care system is unsustainable for doctors like Michael Kahn in New Hampshire, who, as he puts it, spends 20 percent of each day supervising a staff explaining insurance problems to patients, completing authorization forms, and writing appeal letters; a routine that he calls disruptive and distracting, giving him less time to do what he became a doctor to do and actually care for his patients.
Small business owners like Chris and Becky Link in Nashville are also struggling. They've always wanted to do right by the workers at their family-run marketing firm, but have recently had to do the unthinkable and lay off a number of employees – layoffs that could have been deferred, they say, if health care costs weren't so high. Across the country, over one third of small businesses have reduced benefits in recent years and one third have dropped their workers' coverage altogether since the early 90's.
Our largest companies are suffering as well. A big part of what led General Motors and Chrysler into trouble in recent decades were the huge costs they racked up providing health care for their workers; costs that made them less profitable, and less competitive with automakers around the world. If we do not fix our health care system, America may go the way of GM; paying more, getting less, and going broke.
When it comes to the cost of our health care, then, the status quo is unsustainable. Reform is not a luxury, but a necessity. I know there has been much discussion about what reform would cost, and rightly so. This is a test of whether we – Democrats and Republicans alike – are serious about holding the line on new spending and restoring fiscal discipline.
But let there be no doubt – the cost of inaction is greater. If we fail to act, premiums will climb higher, benefits will erode further, and the rolls of uninsured will swell to include millions more Americans.
If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. In thirty years, it will be about one out of every three – a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.
And if we fail to act, federal spending on Medicaid and Medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation's defense. In fact, it will eventually grow larger than what our government spends on anything else today. It's a scenario that will swamp our federal and state budgets, and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our federal and state budgets.
To say it as plainly as I can, health care reform is the single most important thing we can do for America's long-term fiscal health. That is a fact.
And yet, as clear as it is that our system badly needs reform, reform is not inevitable. There's a sense out there among some that, as bad as our current system may be, the devil we know is better than the devil we don't. There is a fear of change – a worry that we may lose what works about our health care system while trying to fix what doesn't.
I understand that fear. I understand that cynicism. They are scars left over from past efforts at reform. Presidents have called for health care reform for nearly a century. Teddy Roosevelt called for it. Harry Truman called for it. Richard Nixon called for it. Jimmy Carter called for it. Bill Clinton called for it. But while significant individual reforms have been made – such as Medicare, Medicaid, and the children's health insurance program – efforts at comprehensive reform that covers everyone and brings down costs have largely failed.
Part of the reason is because the different groups involved – physicians, insurance companies, businesses, workers, and others – simply couldn't agree on the need for reform or what shape it would take. And another part of the reason has been the fierce opposition fueled by some interest groups and lobbyists – opposition that has used fear tactics to paint any effort to achieve reform as an attempt to socialize medicine.
Despite this long history of failure, I am standing here today because I think we are in a different time. One sign that things are different is that just this past week, the Senate passed a bill that will protect children from the dangers of smoking – a reform the AMA has long championed – and one that went nowhere when it was proposed a decade ago. What makes this moment different is that this time – for the first time – key stakeholders are aligning not against, but in favor of reform. They are coming together out of a recognition that while reform will take everyone in our health care community doing their part, ultimately, everyone will benefit.
And I want to commend the AMA, in particular, for offering to do your part to curb costs and achieve reform. A few weeks ago, you joined together with hospitals, labor unions, insurers, medical device manufacturers and drug companies to do something that would've been unthinkable just a few years ago – you promised to work together to cut national health care spending by two trillion dollars over the next decade, relative to what it would otherwise have been. That will bring down costs, that will bring down premiums, and that's exactly the kind of cooperation we need.
The question now is, how do we finish the job? How do we permanently bring down costs and make quality, affordable health care available to every American?
That's what I've come to talk about today. We know the moment is right for health care reform. We know this is an historic opportunity we've never seen before and may not see again. But we also know that there are those who will try and scuttle this opportunity no matter what – who will use the same scare tactics and fear-mongering that's worked in the past. They'll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors. We've heard it all before – and because these fear tactics have worked, things have kept getting worse.
So let me begin by saying this: I know that there are millions of Americans who are content with their health care coverage – they like their plan and they value their relationship with their doctor. And that means that no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what's broken and build on what works.
If we do that, we can build a health care system that allows you to be physicians instead of administrators and accountants; a system that gives Americans the best care at the lowest cost; a system that eases up the pressure on businesses and unleashes the promise of our economy, creating hundreds of thousands of jobs, making take-home wages thousands of dollars higher, and growing our economy by tens of billions more every year. That's how we will stop spending tax dollars to prop up an unsustainable system, and start investing those dollars in innovations and advances that will make our health care system and our economy stronger.
That's what we can do with this opportunity. That's what we must do with this moment.
Now, the good news is that in some instances, there is already widespread agreement on the steps necessary to make our health care system work better.
First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we have already begun to do this with an investment we made as part of our Recovery Act.
It simply doesn't make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere. As Newt Gingrich has rightly pointed out, we do a better job tracking a FedEx package in this country than we do tracking a patient's health records. You shouldn't have to tell every new doctor you see about your medical history, or what prescriptions you're taking. You should not have to repeat costly tests. All of that information should be stored securely in a private medical record so that your information can be tracked from one doctor to another – even if you change jobs, even if you move, and even if you have to see a number of different specialists.
That will not only mean less paper pushing and lower administrative costs, saving taxpayers billions of dollars. It will also make it easier for physicians to do their jobs. It will tell you, the doctors, what drugs a patient is taking so you can avoid prescribing a medication that could cause a harmful interaction. It will help prevent the wrong dosages from going to a patient. And it will reduce medical errors that lead to 100,000 lives lost unnecessarily in our hospitals every year.
The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening. It means going for a run or hitting the gym, and raising our children to step away from the video games and spend more time playing outside.
It also means cutting down on all the junk food that is fueling an epidemic of obesity, putting far too many Americans, young and old, at greater risk of costly, chronic conditions. That's a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted. And that's a lesson that we should work with local school districts to incorporate into their school lunch programs.
Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. It will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. And it will take employers following the example of places like Safeway that is rewarding workers for taking better care of their health while reducing health care costs in the process. If you're one of the three quarters of Safeway workers enrolled in their "Healthy Measures" program, you can get screened for problems like high cholesterol or high blood pressure. And if you score well, you can pay lower premiums. It's a program that has helped Safeway cut health care spending by 13 percent and workers save over 20 percent on their premiums. And we are open to doing more to help employers adopt and expand programs like this one.
Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions – cancer, cardiovascular disease, diabetes, lung disease, and strokes – can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health. That is starting to change with an investment we are making in prevention and wellness programs that can help us avoid diseases that harm our health and the health of our economy.
But as important as they are, investments in electronic records and preventive care are just preliminary steps. They will only make a dent in the epidemic of rising costs in this country.
Despite what some have suggested, the reason we have these costs is not simply because we have an aging population. Demographics do account for part of rising costs because older, sicker societies pay more on health care than younger, healthier ones. But what accounts for the bulk of our costs is the nature of our health care system itself – a system where we spend vast amounts of money on things that aren't making our people any healthier; a system that automatically equates more expensive care with better care.
A recent article in the New Yorker, for example, showed how McAllen, Texas is spending twice as much as El Paso County – not because people in McAllen are sicker and not because they are getting better care. They are simply using more treatments – treatments they don't really need; treatments that, in some cases, can actually do people harm by raising the risk of infection or medical error. And the problem is, this pattern is repeating itself across America. One Dartmouth study showed that you're no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending one.
There are two main reasons for this. The first is a system of incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I'm talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it's not truly necessary. It is a model that has taken the pursuit of medicine from a profession – a calling – to a business.
That is not why you became doctors. That is not why you put in all those hours in the Anatomy Suite or the O.R. That is not what brings you back to a patient's bedside to check in or makes you call a loved one to say it'll be fine. You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers – and that's what our health care system should let you be.
That starts with reforming the way we compensate our doctors and hospitals. We need to bundle payments so you aren't paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up – because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes – so that we are not promoting just more treatment, but better care.
And we need to rethink the cost of a medical education, and do more to reward medical students who choose a career as a primary care physicians and who choose to work in underserved areas instead of a more lucrative path. That's why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren't drowning in debt when they enter the workforce.
The second structural reform we need to make is to improve the quality of medical information making its way to doctors and patients. We have the best medical schools, the most sophisticated labs, and the most advanced training of any nation on the globe. Yet we are not doing a very good job harnessing our collective knowledge and experience on behalf of better medicine. Less than one percent of our health care spending goes to examining what treatments are most effective. And even when that information finds its way into journals, it can take up to 17 years to find its way to an exam room or operating table.
As a result, too many doctors and patients are making decisions without the benefit of the latest research. A recent study, for example, found that only half of all cardiac guidelines are based on scientific evidence. Half. That means doctors may be doing a bypass operation when placing a stent is equally effective, or placing a stent when adjusting a patient's drugs and medical management is equally effective – driving up costs without improving a patient's health.
So, one thing we need to do is figure out what works, and encourage rapid implementation of what works into your practices. That's why we are making a major investment in research to identify the best treatments for a variety of ailments and conditions.
Let me be clear: identifying what works is not about dictating what kind of care should be provided. It's about providing patients and doctors with the information they need to make the best medical decisions.
Still, even when we do know what works, we are often not making the most of it. That's why we need to build on the examples of outstanding medicine at places like the Cincinnati Children's Hospital, where the quality of care for cystic fibrosis patients shot up after the hospital began incorporating suggestions from parents. And places like Tallahassee Memorial Health Care, where deaths were dramatically reduced with rapid response teams that monitored patients' conditions and "multidisciplinary rounds" with everyone from physicians to pharmacists. And places like the Geisinger Health system in rural Pennsylvania and the Intermountain Health in Salt Lake City, where high-quality care is being provided at a cost well below average. These are islands of excellence that we need to make the standard in our health care system.
Replicating best practices. Incentivizing excellence. Closing cost disparities. Any legislation sent to my desk that does not achieve these goals does not earn the title of reform. But my signature on a bill is not enough. I need your help, doctors. To most Americans, you are the health care system. Americans – me included – just do what you recommend. That is why I will listen to you and work with you to pursue reform that works for you. And together, if we take all these steps, we can bring spending down, bring quality up, and save hundreds of billions of dollars on health care costs while making our health care system work better for patients and doctors alike.
Now, I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That's a real issue. And while I'm not advocating caps on malpractice awards which I believe can be unfair to people who've been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That's how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.
These changes need to go hand-in-hand with other reforms. Because our health care system is so complex and medicine is always evolving, we need a way to continually evaluate how we can eliminate waste, reduce costs, and improve quality. That is why I am open to expanding the role of a commission created by a Republican Congress called the Medicare Payment Advisory Commission – which happens to include a number of physicians. In recent years, this commission proposed roughly $200 billion in savings that never made it into law. These recommendations have now been incorporated into our broader reform agenda, but we need to fast-track their proposals in the future so that we don't miss another opportunity to save billions of dollars, as we gain more information about what works and what doesn't in our health care system.
As we seek to contain the cost of health care, we must also ensure that every American can get coverage they can afford. We must do so in part because it is in all of our economic interests. Each time an uninsured American steps foot into an emergency room with no way to reimburse the hospital for care, the cost is handed over to every American family as a bill of about $1,000 that is reflected in higher taxes, higher premiums, and higher health care costs; a hidden tax that will be cut as we insure all Americans. And as we insure every young and healthy American, it will spread out risk for insurance companies, further reducing costs for everyone.
But alongside these economic arguments, there is another, more powerful one. It is simply this: We are not a nation that accepts nearly 46 million uninsured men, women, and children. We are not a nation that lets hardworking families go without the coverage they deserve; or turns its back on those in need. We are a nation that cares for its citizens. We are a people who look out for one another. That is what makes this the United States of America.
So, we need to do a few things to provide affordable health insurance to every single American. The first thing we need to do is protect what's working in our health care system. Let me repeat – if you like your health care, the only thing reform will mean is your health care will cost less. If anyone says otherwise, they are either trying to mislead you or don't have their facts straight.
If you don't like your health coverage or don't have any insurance, you will have a chance to take part in what we're calling a Health Insurance Exchange. This Exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that's best for you and your family – just as federal employees can do, from a postal worker to a Member of Congress. You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package. And one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market so that force waste out of the system and keep the insurance companies honest.
Now, I know there's some concern about a public option. In particular, I understand that you are concerned that today's Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs. These are legitimate concerns, but ones, I believe, that can be overcome. As I stated earlier, the reforms we propose are to reward best practices, focus on patient care, not the current piece-work reimbursement. What we seek is more stability and a health care system on a sound financial footing. And these reforms need to take place regardless of what happens with a public option. With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations about the Sustainable Growth Rate formula that's based on politics and the state of the federal budget in any given year. The alternative is a world where health care costs grow at an unsustainable rate, threatening your reimbursements and the stability of our health care system.
What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. I'll be honest. There are countries where a single-payer system may be working. But I believe – and I've even taken some flak from members of my own party for this belief – that it is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I'm trying to bring about government-run health care, know this – they are not telling the truth.
What I am trying to do – and what a public option will help do – is put affordable health care within reach for millions of Americans. And to help ensure that everyone can afford the cost of a health care option in our Exchange, we need to provide assistance to families who need it. That way, there will be no reason at all for anyone to remain uninsured.
Indeed, it is because I am confident in our ability to give people the ability to get insurance that I am open to a system where every American bears responsibility for owning health insurance, so long as we provide a hardship waiver for those who still can't afford it. The same is true for employers. While I believe every business has a responsibility to provide health insurance for its workers, small businesses that cannot afford it should receive an exemption. And small business workers and their families will be able to seek coverage in the Exchange if their employer is not able to provide it.
Insurance companies have expressed support for the idea of covering the uninsured – and I welcome their willingness to engage constructively in the reform debate. But what I refuse to do is simply create a system where insurance companies have more customers on Uncle Sam's dime, but still fail to meet their responsibilities. That is why we need to end the practice of denying coverage on the basis of preexisting conditions. The days of cherry-picking who to cover and who to deny – those days are over.
This is personal for me. I will never forget watching my own mother, as she fought cancer in her final days, worrying about whether her insurer would claim her illness was a preexisting condition so it could get out of providing coverage. Changing the current approach to preexisting conditions is the least we can do – for my mother and every other mother, father, son, and daughter, who has suffered under this practice. And it will put health care within reach for millions of Americans.
Now, even if we accept all of the economic and moral reasons for providing affordable coverage to all Americans, there is no denying that it will come at a cost – at least in the short run. But it is a cost that will not – I repeat, not – add to our deficits. Health care reform must be and will be deficit neutral in the next decade.
There are already voices saying the numbers don't add up. They are wrong. Here's why. Making health care affordable for all Americans will cost somewhere on the order of one trillion dollars over the next ten years. That sounds like a lot of money – and it is. But remember: it is less than we are projected to spend on the war in Iraq. And also remember: failing to reform our health care system in a way that genuinely reduces cost growth will cost us trillions of dollars more in lost economic growth and lower wages.
That said, let me explain how we will cover the price tag. First, as part of the budget that was passed a few months ago, we've put aside $635 billion over ten years in what we are calling a Health Reserve Fund. Over half of that amount – more than $300 billion – will come from raising revenue by doing things like modestly limiting the tax deductions the wealthiest Americans can take to the same level it was at the end of the Reagan years. Some are concerned this will dramatically reduce charitable giving, but statistics show that's not true, and the best thing for our charities is the stronger economy that we will build with health care reform.
But we cannot just raise revenues. We also have to make spending cuts in part by examining inefficiencies in the Medicare program. There will be a robust debate about where these cuts should be made, and I welcome that debate. But here's where I think these cuts should be made. First, we should end overpayments to Medicare Advantage. Today, we are paying Medicare Advantage plans much more than we pay for traditional Medicare services. That's a good deal for insurance companies, but not the American people. That's why we need to introduce competitive bidding into the Medicare Advantage program, a program under which private insurance companies offer Medicare coverage. That will save $177 billion over the next decade.
Second, we need to use Medicare reimbursements to reduce preventable hospital readmissions. Right now, almost 20 percent of Medicare patients discharged from hospitals are readmitted within a month, often because they are not getting the comprehensive care they need. This puts people at risk and drives up costs. By changing how Medicare reimburses hospitals, we can discourage them from acting in a way that boosts profits, but drives up costs for everyone else. That will save us $25 billion over the next decade.
Third, we need to introduce generic biologic drugs into the marketplace. These are drugs used to treat illnesses like anemia. But right now, there is no pathway at the FDA for approving generic versions of these drugs. Creating such a pathway will save us billions of dollars. And we can save another roughly $30 billion by getting a better deal for our poorer seniors while asking our well-off seniors to pay a little more for their drugs.
So, that's the bulk of what's in the Health Reserve Fund. I have also proposed saving another $313 billion in Medicare and Medicaid spending in several other ways. One way is by adjusting Medicare payments to reflect new advances and productivity gains in our economy. Right now, Medicare payments are rising each year by more than they should. These adjustments will create incentives for providers to deliver care more effectively, and save us roughly $109 billion in the process.
Another way we can achieve savings is by reducing payments to hospitals for treating uninsured people. I know hospitals rely on these payments now because of the large number of uninsured patients they treat. But as the number of uninsured people goes down with our reforms, the amount we pay hospitals to treat uninsured people should go down, as well. Reducing these payments gradually as more and more people have coverage will save us over $106 billion, and we'll make sure the difference goes to the hospitals that most need it.
We can also save about $75 billion through more efficient purchasing of prescription drugs. And we can save about one billion more by rooting out waste, abuse, and fraud throughout our health care system so that no one is charging more for a service than it's worth or charging a dime for a service they did not provide.
But let me be clear: I am committed to making these cuts in a way that protects our senior citizens. In fact, these proposals will actually extend the life of the Medicare Trust Fund by 7 years and reduce premiums for Medicare beneficiaries by roughly $43 billion over 10 years. And I'm working with AARP to uphold that commitment.
Altogether, these savings mean that we have put about $950 billion on the table – not counting some of the longer-term savings that will come about from reform – taking us almost all the way to covering the full cost of health care reform. In the weeks and months ahead, I look forward to working with Congress to make up the difference so that health care reform is fully paid for – in a real, accountable way. And let me add that this does not count some of the longer-term savings that will come about from health care reform. By insisting that reform be deficit neutral over the next decade and by making the reforms that will help slow the growth rate of health care costs over coming decades, we can look forward to faster economic growth, higher living standards, and falling, not rising, budget deficits.
I know people are cynical we can do this. I know there will be disagreements about how to proceed in the days ahead. But I also know that we cannot let this moment pass us by.
The other day, my friend, Congressman Earl Blumenauer, handed me a magazine with a special issue titled, "The Crisis in American Medicine." One article notes "soaring charges." Another warns about the "volume of utilization of services." And another asks if we can find a "better way [than fee-for-service] for paying for medical care." It speaks to many of the challenges we face today. The thing is, this special issue was published by Harper's Magazine in October of 1960.
Members of the American Medical Association – my fellow Americans – I am here today because I do not want our children and their children to still be speaking of a crisis in American medicine fifty years from now. I do not want them to still be suffering from spiraling costs we did not stem, or sicknesses we did not cure. I do not want them to be burdened with massive deficits we did not curb or a worsening economy we did not rebuild.
I want them to benefit from a health care system that works for all of us; where families can open a doctor's bill without dreading what's inside; where parents are taking their kids to get regular checkups and testing themselves for preventable ailments; where parents are feeding their kids healthier food and kids are exercising more; where patients are spending more time with doctors and doctors can pull up on a computer all the medical information and latest research they'd ever want to meet that patient's needs; where orthopedists and nephrologists and oncologists are all working together to treat a single human being; where what's best about America's health care system has become the hallmark of America's health care system.
That is the health care system we can build. That is the future within our reach. And if we are willing to come together and bring about that future, then we will not only make Americans healthier and not only unleash America's economic potential, but we will reaffirm the ideals that led you into this noble profession, and build a health care system that lets all Americans heal. Thank you.
From the moment I took office as President, the central challenge we have confronted as a nation has been the need to lift ourselves out of the worst recession since World War II. In recent months, we have taken a series of extraordinary steps, not just to repair the immediate damage to our economy, but to build a new foundation for lasting and sustained growth. We are creating new jobs. We are unfreezing our credit markets. And we are stemming the loss of homes and the decline of home values.
But even as we have made progress, we know that the road to prosperity remains long and difficult. We also know that one essential step on our journey is to control the spiraling cost of health care in America.
Today, we are spending over $2 trillion a year on health care – almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren't any healthier. In fact, citizens in some countries that spend less than we do are actually living longer than we do.
Make no mistake: the cost of our health care is a threat to our economy. It is an escalating burden on our families and businesses. It is a ticking time-bomb for the federal budget. And it is unsustainable for the United States of America.
It is unsustainable for Americans like Laura Klitzka, a young mother I met in Wisconsin last week, who has learned that the breast cancer she thought she'd beaten had spread to her bones; who is now being forced to spend time worrying about how to cover the $50,000 in medical debts she has already accumulated, when all she wants to do is spend time with her two children and focus on getting well. These are not worries a woman like Laura should have to face in a nation as wealthy as ours.
Stories like Laura's are being told by women and men all across this country – by families who have seen out-of-pocket costs soar, and premiums double over the last decade at a rate three times faster than wages. This is forcing Americans of all ages to go without the checkups or prescriptions they need. It's creating a situation where a single illness can wipe out a lifetime of savings.
Our costly health care system is unsustainable for doctors like Michael Kahn in New Hampshire, who, as he puts it, spends 20 percent of each day supervising a staff explaining insurance problems to patients, completing authorization forms, and writing appeal letters; a routine that he calls disruptive and distracting, giving him less time to do what he became a doctor to do and actually care for his patients.
Small business owners like Chris and Becky Link in Nashville are also struggling. They've always wanted to do right by the workers at their family-run marketing firm, but have recently had to do the unthinkable and lay off a number of employees – layoffs that could have been deferred, they say, if health care costs weren't so high. Across the country, over one third of small businesses have reduced benefits in recent years and one third have dropped their workers' coverage altogether since the early 90's.
Our largest companies are suffering as well. A big part of what led General Motors and Chrysler into trouble in recent decades were the huge costs they racked up providing health care for their workers; costs that made them less profitable, and less competitive with automakers around the world. If we do not fix our health care system, America may go the way of GM; paying more, getting less, and going broke.
When it comes to the cost of our health care, then, the status quo is unsustainable. Reform is not a luxury, but a necessity. I know there has been much discussion about what reform would cost, and rightly so. This is a test of whether we – Democrats and Republicans alike – are serious about holding the line on new spending and restoring fiscal discipline.
But let there be no doubt – the cost of inaction is greater. If we fail to act, premiums will climb higher, benefits will erode further, and the rolls of uninsured will swell to include millions more Americans.
If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. In thirty years, it will be about one out of every three – a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.
And if we fail to act, federal spending on Medicaid and Medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation's defense. In fact, it will eventually grow larger than what our government spends on anything else today. It's a scenario that will swamp our federal and state budgets, and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our federal and state budgets.
To say it as plainly as I can, health care reform is the single most important thing we can do for America's long-term fiscal health. That is a fact.
And yet, as clear as it is that our system badly needs reform, reform is not inevitable. There's a sense out there among some that, as bad as our current system may be, the devil we know is better than the devil we don't. There is a fear of change – a worry that we may lose what works about our health care system while trying to fix what doesn't.
I understand that fear. I understand that cynicism. They are scars left over from past efforts at reform. Presidents have called for health care reform for nearly a century. Teddy Roosevelt called for it. Harry Truman called for it. Richard Nixon called for it. Jimmy Carter called for it. Bill Clinton called for it. But while significant individual reforms have been made – such as Medicare, Medicaid, and the children's health insurance program – efforts at comprehensive reform that covers everyone and brings down costs have largely failed.
Part of the reason is because the different groups involved – physicians, insurance companies, businesses, workers, and others – simply couldn't agree on the need for reform or what shape it would take. And another part of the reason has been the fierce opposition fueled by some interest groups and lobbyists – opposition that has used fear tactics to paint any effort to achieve reform as an attempt to socialize medicine.
Despite this long history of failure, I am standing here today because I think we are in a different time. One sign that things are different is that just this past week, the Senate passed a bill that will protect children from the dangers of smoking – a reform the AMA has long championed – and one that went nowhere when it was proposed a decade ago. What makes this moment different is that this time – for the first time – key stakeholders are aligning not against, but in favor of reform. They are coming together out of a recognition that while reform will take everyone in our health care community doing their part, ultimately, everyone will benefit.
And I want to commend the AMA, in particular, for offering to do your part to curb costs and achieve reform. A few weeks ago, you joined together with hospitals, labor unions, insurers, medical device manufacturers and drug companies to do something that would've been unthinkable just a few years ago – you promised to work together to cut national health care spending by two trillion dollars over the next decade, relative to what it would otherwise have been. That will bring down costs, that will bring down premiums, and that's exactly the kind of cooperation we need.
The question now is, how do we finish the job? How do we permanently bring down costs and make quality, affordable health care available to every American?
That's what I've come to talk about today. We know the moment is right for health care reform. We know this is an historic opportunity we've never seen before and may not see again. But we also know that there are those who will try and scuttle this opportunity no matter what – who will use the same scare tactics and fear-mongering that's worked in the past. They'll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors. We've heard it all before – and because these fear tactics have worked, things have kept getting worse.
So let me begin by saying this: I know that there are millions of Americans who are content with their health care coverage – they like their plan and they value their relationship with their doctor. And that means that no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what's broken and build on what works.
If we do that, we can build a health care system that allows you to be physicians instead of administrators and accountants; a system that gives Americans the best care at the lowest cost; a system that eases up the pressure on businesses and unleashes the promise of our economy, creating hundreds of thousands of jobs, making take-home wages thousands of dollars higher, and growing our economy by tens of billions more every year. That's how we will stop spending tax dollars to prop up an unsustainable system, and start investing those dollars in innovations and advances that will make our health care system and our economy stronger.
That's what we can do with this opportunity. That's what we must do with this moment.
Now, the good news is that in some instances, there is already widespread agreement on the steps necessary to make our health care system work better.
First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we have already begun to do this with an investment we made as part of our Recovery Act.
It simply doesn't make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere. As Newt Gingrich has rightly pointed out, we do a better job tracking a FedEx package in this country than we do tracking a patient's health records. You shouldn't have to tell every new doctor you see about your medical history, or what prescriptions you're taking. You should not have to repeat costly tests. All of that information should be stored securely in a private medical record so that your information can be tracked from one doctor to another – even if you change jobs, even if you move, and even if you have to see a number of different specialists.
That will not only mean less paper pushing and lower administrative costs, saving taxpayers billions of dollars. It will also make it easier for physicians to do their jobs. It will tell you, the doctors, what drugs a patient is taking so you can avoid prescribing a medication that could cause a harmful interaction. It will help prevent the wrong dosages from going to a patient. And it will reduce medical errors that lead to 100,000 lives lost unnecessarily in our hospitals every year.
The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening. It means going for a run or hitting the gym, and raising our children to step away from the video games and spend more time playing outside.
It also means cutting down on all the junk food that is fueling an epidemic of obesity, putting far too many Americans, young and old, at greater risk of costly, chronic conditions. That's a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted. And that's a lesson that we should work with local school districts to incorporate into their school lunch programs.
Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. It will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. And it will take employers following the example of places like Safeway that is rewarding workers for taking better care of their health while reducing health care costs in the process. If you're one of the three quarters of Safeway workers enrolled in their "Healthy Measures" program, you can get screened for problems like high cholesterol or high blood pressure. And if you score well, you can pay lower premiums. It's a program that has helped Safeway cut health care spending by 13 percent and workers save over 20 percent on their premiums. And we are open to doing more to help employers adopt and expand programs like this one.
Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions – cancer, cardiovascular disease, diabetes, lung disease, and strokes – can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health. That is starting to change with an investment we are making in prevention and wellness programs that can help us avoid diseases that harm our health and the health of our economy.
But as important as they are, investments in electronic records and preventive care are just preliminary steps. They will only make a dent in the epidemic of rising costs in this country.
Despite what some have suggested, the reason we have these costs is not simply because we have an aging population. Demographics do account for part of rising costs because older, sicker societies pay more on health care than younger, healthier ones. But what accounts for the bulk of our costs is the nature of our health care system itself – a system where we spend vast amounts of money on things that aren't making our people any healthier; a system that automatically equates more expensive care with better care.
A recent article in the New Yorker, for example, showed how McAllen, Texas is spending twice as much as El Paso County – not because people in McAllen are sicker and not because they are getting better care. They are simply using more treatments – treatments they don't really need; treatments that, in some cases, can actually do people harm by raising the risk of infection or medical error. And the problem is, this pattern is repeating itself across America. One Dartmouth study showed that you're no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending one.
There are two main reasons for this. The first is a system of incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I'm talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it's not truly necessary. It is a model that has taken the pursuit of medicine from a profession – a calling – to a business.
That is not why you became doctors. That is not why you put in all those hours in the Anatomy Suite or the O.R. That is not what brings you back to a patient's bedside to check in or makes you call a loved one to say it'll be fine. You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers – and that's what our health care system should let you be.
That starts with reforming the way we compensate our doctors and hospitals. We need to bundle payments so you aren't paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up – because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes – so that we are not promoting just more treatment, but better care.
And we need to rethink the cost of a medical education, and do more to reward medical students who choose a career as a primary care physicians and who choose to work in underserved areas instead of a more lucrative path. That's why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren't drowning in debt when they enter the workforce.
The second structural reform we need to make is to improve the quality of medical information making its way to doctors and patients. We have the best medical schools, the most sophisticated labs, and the most advanced training of any nation on the globe. Yet we are not doing a very good job harnessing our collective knowledge and experience on behalf of better medicine. Less than one percent of our health care spending goes to examining what treatments are most effective. And even when that information finds its way into journals, it can take up to 17 years to find its way to an exam room or operating table.
As a result, too many doctors and patients are making decisions without the benefit of the latest research. A recent study, for example, found that only half of all cardiac guidelines are based on scientific evidence. Half. That means doctors may be doing a bypass operation when placing a stent is equally effective, or placing a stent when adjusting a patient's drugs and medical management is equally effective – driving up costs without improving a patient's health.
So, one thing we need to do is figure out what works, and encourage rapid implementation of what works into your practices. That's why we are making a major investment in research to identify the best treatments for a variety of ailments and conditions.
Let me be clear: identifying what works is not about dictating what kind of care should be provided. It's about providing patients and doctors with the information they need to make the best medical decisions.
Still, even when we do know what works, we are often not making the most of it. That's why we need to build on the examples of outstanding medicine at places like the Cincinnati Children's Hospital, where the quality of care for cystic fibrosis patients shot up after the hospital began incorporating suggestions from parents. And places like Tallahassee Memorial Health Care, where deaths were dramatically reduced with rapid response teams that monitored patients' conditions and "multidisciplinary rounds" with everyone from physicians to pharmacists. And places like the Geisinger Health system in rural Pennsylvania and the Intermountain Health in Salt Lake City, where high-quality care is being provided at a cost well below average. These are islands of excellence that we need to make the standard in our health care system.
Replicating best practices. Incentivizing excellence. Closing cost disparities. Any legislation sent to my desk that does not achieve these goals does not earn the title of reform. But my signature on a bill is not enough. I need your help, doctors. To most Americans, you are the health care system. Americans – me included – just do what you recommend. That is why I will listen to you and work with you to pursue reform that works for you. And together, if we take all these steps, we can bring spending down, bring quality up, and save hundreds of billions of dollars on health care costs while making our health care system work better for patients and doctors alike.
Now, I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That's a real issue. And while I'm not advocating caps on malpractice awards which I believe can be unfair to people who've been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That's how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.
These changes need to go hand-in-hand with other reforms. Because our health care system is so complex and medicine is always evolving, we need a way to continually evaluate how we can eliminate waste, reduce costs, and improve quality. That is why I am open to expanding the role of a commission created by a Republican Congress called the Medicare Payment Advisory Commission – which happens to include a number of physicians. In recent years, this commission proposed roughly $200 billion in savings that never made it into law. These recommendations have now been incorporated into our broader reform agenda, but we need to fast-track their proposals in the future so that we don't miss another opportunity to save billions of dollars, as we gain more information about what works and what doesn't in our health care system.
As we seek to contain the cost of health care, we must also ensure that every American can get coverage they can afford. We must do so in part because it is in all of our economic interests. Each time an uninsured American steps foot into an emergency room with no way to reimburse the hospital for care, the cost is handed over to every American family as a bill of about $1,000 that is reflected in higher taxes, higher premiums, and higher health care costs; a hidden tax that will be cut as we insure all Americans. And as we insure every young and healthy American, it will spread out risk for insurance companies, further reducing costs for everyone.
But alongside these economic arguments, there is another, more powerful one. It is simply this: We are not a nation that accepts nearly 46 million uninsured men, women, and children. We are not a nation that lets hardworking families go without the coverage they deserve; or turns its back on those in need. We are a nation that cares for its citizens. We are a people who look out for one another. That is what makes this the United States of America.
So, we need to do a few things to provide affordable health insurance to every single American. The first thing we need to do is protect what's working in our health care system. Let me repeat – if you like your health care, the only thing reform will mean is your health care will cost less. If anyone says otherwise, they are either trying to mislead you or don't have their facts straight.
If you don't like your health coverage or don't have any insurance, you will have a chance to take part in what we're calling a Health Insurance Exchange. This Exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that's best for you and your family – just as federal employees can do, from a postal worker to a Member of Congress. You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package. And one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market so that force waste out of the system and keep the insurance companies honest.
Now, I know there's some concern about a public option. In particular, I understand that you are concerned that today's Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs. These are legitimate concerns, but ones, I believe, that can be overcome. As I stated earlier, the reforms we propose are to reward best practices, focus on patient care, not the current piece-work reimbursement. What we seek is more stability and a health care system on a sound financial footing. And these reforms need to take place regardless of what happens with a public option. With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations about the Sustainable Growth Rate formula that's based on politics and the state of the federal budget in any given year. The alternative is a world where health care costs grow at an unsustainable rate, threatening your reimbursements and the stability of our health care system.
What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. I'll be honest. There are countries where a single-payer system may be working. But I believe – and I've even taken some flak from members of my own party for this belief – that it is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I'm trying to bring about government-run health care, know this – they are not telling the truth.
What I am trying to do – and what a public option will help do – is put affordable health care within reach for millions of Americans. And to help ensure that everyone can afford the cost of a health care option in our Exchange, we need to provide assistance to families who need it. That way, there will be no reason at all for anyone to remain uninsured.
Indeed, it is because I am confident in our ability to give people the ability to get insurance that I am open to a system where every American bears responsibility for owning health insurance, so long as we provide a hardship waiver for those who still can't afford it. The same is true for employers. While I believe every business has a responsibility to provide health insurance for its workers, small businesses that cannot afford it should receive an exemption. And small business workers and their families will be able to seek coverage in the Exchange if their employer is not able to provide it.
Insurance companies have expressed support for the idea of covering the uninsured – and I welcome their willingness to engage constructively in the reform debate. But what I refuse to do is simply create a system where insurance companies have more customers on Uncle Sam's dime, but still fail to meet their responsibilities. That is why we need to end the practice of denying coverage on the basis of preexisting conditions. The days of cherry-picking who to cover and who to deny – those days are over.
This is personal for me. I will never forget watching my own mother, as she fought cancer in her final days, worrying about whether her insurer would claim her illness was a preexisting condition so it could get out of providing coverage. Changing the current approach to preexisting conditions is the least we can do – for my mother and every other mother, father, son, and daughter, who has suffered under this practice. And it will put health care within reach for millions of Americans.
Now, even if we accept all of the economic and moral reasons for providing affordable coverage to all Americans, there is no denying that it will come at a cost – at least in the short run. But it is a cost that will not – I repeat, not – add to our deficits. Health care reform must be and will be deficit neutral in the next decade.
There are already voices saying the numbers don't add up. They are wrong. Here's why. Making health care affordable for all Americans will cost somewhere on the order of one trillion dollars over the next ten years. That sounds like a lot of money – and it is. But remember: it is less than we are projected to spend on the war in Iraq. And also remember: failing to reform our health care system in a way that genuinely reduces cost growth will cost us trillions of dollars more in lost economic growth and lower wages.
That said, let me explain how we will cover the price tag. First, as part of the budget that was passed a few months ago, we've put aside $635 billion over ten years in what we are calling a Health Reserve Fund. Over half of that amount – more than $300 billion – will come from raising revenue by doing things like modestly limiting the tax deductions the wealthiest Americans can take to the same level it was at the end of the Reagan years. Some are concerned this will dramatically reduce charitable giving, but statistics show that's not true, and the best thing for our charities is the stronger economy that we will build with health care reform.
But we cannot just raise revenues. We also have to make spending cuts in part by examining inefficiencies in the Medicare program. There will be a robust debate about where these cuts should be made, and I welcome that debate. But here's where I think these cuts should be made. First, we should end overpayments to Medicare Advantage. Today, we are paying Medicare Advantage plans much more than we pay for traditional Medicare services. That's a good deal for insurance companies, but not the American people. That's why we need to introduce competitive bidding into the Medicare Advantage program, a program under which private insurance companies offer Medicare coverage. That will save $177 billion over the next decade.
Second, we need to use Medicare reimbursements to reduce preventable hospital readmissions. Right now, almost 20 percent of Medicare patients discharged from hospitals are readmitted within a month, often because they are not getting the comprehensive care they need. This puts people at risk and drives up costs. By changing how Medicare reimburses hospitals, we can discourage them from acting in a way that boosts profits, but drives up costs for everyone else. That will save us $25 billion over the next decade.
Third, we need to introduce generic biologic drugs into the marketplace. These are drugs used to treat illnesses like anemia. But right now, there is no pathway at the FDA for approving generic versions of these drugs. Creating such a pathway will save us billions of dollars. And we can save another roughly $30 billion by getting a better deal for our poorer seniors while asking our well-off seniors to pay a little more for their drugs.
So, that's the bulk of what's in the Health Reserve Fund. I have also proposed saving another $313 billion in Medicare and Medicaid spending in several other ways. One way is by adjusting Medicare payments to reflect new advances and productivity gains in our economy. Right now, Medicare payments are rising each year by more than they should. These adjustments will create incentives for providers to deliver care more effectively, and save us roughly $109 billion in the process.
Another way we can achieve savings is by reducing payments to hospitals for treating uninsured people. I know hospitals rely on these payments now because of the large number of uninsured patients they treat. But as the number of uninsured people goes down with our reforms, the amount we pay hospitals to treat uninsured people should go down, as well. Reducing these payments gradually as more and more people have coverage will save us over $106 billion, and we'll make sure the difference goes to the hospitals that most need it.
We can also save about $75 billion through more efficient purchasing of prescription drugs. And we can save about one billion more by rooting out waste, abuse, and fraud throughout our health care system so that no one is charging more for a service than it's worth or charging a dime for a service they did not provide.
But let me be clear: I am committed to making these cuts in a way that protects our senior citizens. In fact, these proposals will actually extend the life of the Medicare Trust Fund by 7 years and reduce premiums for Medicare beneficiaries by roughly $43 billion over 10 years. And I'm working with AARP to uphold that commitment.
Altogether, these savings mean that we have put about $950 billion on the table – not counting some of the longer-term savings that will come about from reform – taking us almost all the way to covering the full cost of health care reform. In the weeks and months ahead, I look forward to working with Congress to make up the difference so that health care reform is fully paid for – in a real, accountable way. And let me add that this does not count some of the longer-term savings that will come about from health care reform. By insisting that reform be deficit neutral over the next decade and by making the reforms that will help slow the growth rate of health care costs over coming decades, we can look forward to faster economic growth, higher living standards, and falling, not rising, budget deficits.
I know people are cynical we can do this. I know there will be disagreements about how to proceed in the days ahead. But I also know that we cannot let this moment pass us by.
The other day, my friend, Congressman Earl Blumenauer, handed me a magazine with a special issue titled, "The Crisis in American Medicine." One article notes "soaring charges." Another warns about the "volume of utilization of services." And another asks if we can find a "better way [than fee-for-service] for paying for medical care." It speaks to many of the challenges we face today. The thing is, this special issue was published by Harper's Magazine in October of 1960.
Members of the American Medical Association – my fellow Americans – I am here today because I do not want our children and their children to still be speaking of a crisis in American medicine fifty years from now. I do not want them to still be suffering from spiraling costs we did not stem, or sicknesses we did not cure. I do not want them to be burdened with massive deficits we did not curb or a worsening economy we did not rebuild.
I want them to benefit from a health care system that works for all of us; where families can open a doctor's bill without dreading what's inside; where parents are taking their kids to get regular checkups and testing themselves for preventable ailments; where parents are feeding their kids healthier food and kids are exercising more; where patients are spending more time with doctors and doctors can pull up on a computer all the medical information and latest research they'd ever want to meet that patient's needs; where orthopedists and nephrologists and oncologists are all working together to treat a single human being; where what's best about America's health care system has become the hallmark of America's health care system.
That is the health care system we can build. That is the future within our reach. And if we are willing to come together and bring about that future, then we will not only make Americans healthier and not only unleash America's economic potential, but we will reaffirm the ideals that led you into this noble profession, and build a health care system that lets all Americans heal. Thank you.
THE OTHER SIDE OF HEALTH CARE DEBATE?
Wrong Way on Health 'Reform' Washington POST By Robert J. Samuelson
It's hard to know whether President Obama's health-care "reform" is naive, hypocritical or simply dishonest. Probably all three. The president keeps saying it's imperative to control runaway health spending. He's right. The trouble is that what's being promoted as health-care "reform" almost certainly won't suppress spending and, quite probably, will do the opposite.
A new report from Obama's own Council of Economic Advisers shows why controlling health costs is so important. Since 1975, annual health spending per person, adjusted for inflation, has grown 2.1 percentage points faster than overall economic growth per person. If this trend continues, the CEA projects that:
-- Health spending, which was 5 percent of the economy (gross domestic product) in 1960 and is reckoned at almost 18 percent today, would grow to 34 percent of GDP by 2040 -- a third of the economy.
-- Medicare and Medicaid, the government insurance programs for the elderly and poor, would increase from 6 percent of GDP now to 15 percent in 2040 -- roughly equal to three-quarters of present federal spending.
-- Employer-paid insurance premiums for family coverage, which grew 85 percent in inflation-adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040 (all figures in "constant 2008 dollars"). The huge costs would force employers to reduce take-home pay.
The message in these dismal figures is that uncontrolled health spending is almost single-handedly determining national priorities. It's reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs. Worse, much medical spending is wasted, the CEA report says. It doesn't improve Americans' health; some care is unneeded or ineffective.
The Obama administration's response is to talk endlessly about restraining health spending -- "bending the curve" is the buzz -- as if talk will suffice. The president summoned the heads of major health-care groups representing doctors, hospitals, drug companies and medical device firms to the White House. All pledged to bend the curve. This is mostly public relations. Does anyone believe the American Medical Association can control the nation's 800,000 doctors or that the American Hospital Association can command the 5,700 hospitals?
The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services -- and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.
That's the crux of the health-care dilemma, and Obama hasn't confronted it. His emphasis on controlling costs is cosmetic. The main aim of health-care "reform" being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem.
How much healthier today's uninsured would be with that coverage is unclear. They already receive health care -- $116 billion worth in 2008, estimates Families USA, an advocacy group. Some is paid by the uninsured themselves (37 percent), some by government and charities (26 percent). The remaining "uncompensated care" is either absorbed by doctors and hospitals or shifted to higher private insurance premiums. Some uninsured would benefit from coverage, but others wouldn't. Either they're healthy (40 percent are between ages 18 and 34) or would get ineffective care.
The one certain consequence of expanding insurance coverage is that it would raise spending. When people have insurance, they use more health services. That's one reason Obama's campaign proposal was estimated to cost $1.2 trillion over a decade (the other reason is that the federal government would pick up some costs now paid by others). Indeed, the higher demand for health care might raise costs across the board, increasing both government spending and private premiums.
No doubt the health program that Congress fashions will counter this reality by including some provisions intended to cut costs ("bundled payments" to hospitals, "evidence-based guidelines," electronic recordkeeping). In the past, scattershot measures have barely affected health spending. What's needed is a fundamental remaking of the health-care sector -- a sweeping "restructuring" -- that would overhaul fee-for-service payment and reduce the fragmentation of care.
The place to start would be costly Medicare, the nation's largest insurance program serving 45 million elderly and disabled. Of course, this would be unpopular, because it would disrupt delivery patterns and reimbursement practices. It's easier to pretend to be curbing health spending while expanding coverage and spending. Presidents have done that for decades, and it's why most health industries see "reform" as a good deal.
It's hard to know whether President Obama's health-care "reform" is naive, hypocritical or simply dishonest. Probably all three. The president keeps saying it's imperative to control runaway health spending. He's right. The trouble is that what's being promoted as health-care "reform" almost certainly won't suppress spending and, quite probably, will do the opposite.
A new report from Obama's own Council of Economic Advisers shows why controlling health costs is so important. Since 1975, annual health spending per person, adjusted for inflation, has grown 2.1 percentage points faster than overall economic growth per person. If this trend continues, the CEA projects that:
-- Health spending, which was 5 percent of the economy (gross domestic product) in 1960 and is reckoned at almost 18 percent today, would grow to 34 percent of GDP by 2040 -- a third of the economy.
-- Medicare and Medicaid, the government insurance programs for the elderly and poor, would increase from 6 percent of GDP now to 15 percent in 2040 -- roughly equal to three-quarters of present federal spending.
-- Employer-paid insurance premiums for family coverage, which grew 85 percent in inflation-adjusted terms from 1996 to $11,941 in 2006, would increase to $25,200 by 2025 and $45,000 in 2040 (all figures in "constant 2008 dollars"). The huge costs would force employers to reduce take-home pay.
The message in these dismal figures is that uncontrolled health spending is almost single-handedly determining national priorities. It's reducing discretionary income, raising taxes, widening budget deficits and squeezing other government programs. Worse, much medical spending is wasted, the CEA report says. It doesn't improve Americans' health; some care is unneeded or ineffective.
The Obama administration's response is to talk endlessly about restraining health spending -- "bending the curve" is the buzz -- as if talk will suffice. The president summoned the heads of major health-care groups representing doctors, hospitals, drug companies and medical device firms to the White House. All pledged to bend the curve. This is mostly public relations. Does anyone believe the American Medical Association can control the nation's 800,000 doctors or that the American Hospital Association can command the 5,700 hospitals?
The central cause of runaway health spending is clear. Hospitals and doctors are paid mostly on a fee-for-service basis and reimbursed by insurance, either private or governmental. The open-ended payment system encourages doctors and hospitals to provide more services -- and patients to expect them. It also favors new medical technologies, which are made profitable by heavy use. Unfortunately, what pleases providers and patients individually hurts the nation as a whole.
That's the crux of the health-care dilemma, and Obama hasn't confronted it. His emphasis on controlling costs is cosmetic. The main aim of health-care "reform" being fashioned in Congress is to provide insurance to most of the 46 million uncovered Americans. This is popular and seems the moral thing to do. After all, hardly anyone wants to be without insurance. But the extra coverage might actually worsen the spending problem.
How much healthier today's uninsured would be with that coverage is unclear. They already receive health care -- $116 billion worth in 2008, estimates Families USA, an advocacy group. Some is paid by the uninsured themselves (37 percent), some by government and charities (26 percent). The remaining "uncompensated care" is either absorbed by doctors and hospitals or shifted to higher private insurance premiums. Some uninsured would benefit from coverage, but others wouldn't. Either they're healthy (40 percent are between ages 18 and 34) or would get ineffective care.
The one certain consequence of expanding insurance coverage is that it would raise spending. When people have insurance, they use more health services. That's one reason Obama's campaign proposal was estimated to cost $1.2 trillion over a decade (the other reason is that the federal government would pick up some costs now paid by others). Indeed, the higher demand for health care might raise costs across the board, increasing both government spending and private premiums.
No doubt the health program that Congress fashions will counter this reality by including some provisions intended to cut costs ("bundled payments" to hospitals, "evidence-based guidelines," electronic recordkeeping). In the past, scattershot measures have barely affected health spending. What's needed is a fundamental remaking of the health-care sector -- a sweeping "restructuring" -- that would overhaul fee-for-service payment and reduce the fragmentation of care.
The place to start would be costly Medicare, the nation's largest insurance program serving 45 million elderly and disabled. Of course, this would be unpopular, because it would disrupt delivery patterns and reimbursement practices. It's easier to pretend to be curbing health spending while expanding coverage and spending. Presidents have done that for decades, and it's why most health industries see "reform" as a good deal.
Britain to Investigate Role in Iraq
JOHN F. BURNS
LONDON — After years of delay, the British government said Monday it would go ahead with an inquiry into the country’s role in the Iraq war, an issue that has been deeply divisive ever since the former prime minister, Tony Blair, committed more than 40,000 troops to the invasion in 2003.
Britain’s combat role ended in April, and the last British troops are scheduled to withdraw from their base at the southern city of Basra by July 30, their role taken over by American troops. Prime Minister Gordon Brown, under pressure for an inquiry from his own Labor party and from the opposition Conservatives, has long insisted that the British role in the war should be ended first.
Mr. Brown was scheduled to make a statement on the inquiry in the House of Commons on Monday afternoon, but the decision to go ahead was confirmed by Michael Ellam, his spokesman at 10 Downing Street. Key issues to be settled by the prime minister include whether the inquiry will be held in public or in private, and whether it will review the political decisions that led to war, as well as the conduct of military operations.
Few issues in Britain have been as contentious in the past generation as the decision to join the United States in the 2003 invasion. The commitment took on the character of a personal mission for Mr. Blair, who prevailed over a divided cabinet and Britain’s largest street protests in decades in forging the war coalition with former American president, George W. Bush.
It was an improbable partnership, given the wide philosophical differences between Mr. Blair’s Labor party and the conservative Republicanism of Mr. Bush. It ended, for Mr. Blair, two years ago this month, when he was hastened from office after 10 years by a left-of-center cabal led by Mr. Brown, his successor as prime minister, whose campaign to oust Mr. Blair rested in large part with the party’s unreconciled opposition to the war.
Mr. Blair has gone on to become a Middle East peace negotiator and a highly paid adviser to international banks, as well as a much-sought-after public speaker, particularly in the United States. He is said to have amassed a personal fortune of about $32 million. Mr. Brown, meanwhile, has seen Labor’s political fortunes plunge for reasons not related to the Iraq war, and narrowly survived a cabinet revolt earlier this month that threatened to unseat him.
He has had to tread warily in ordering a formal war inquiry. If the probe examines the political decision-making that preceded the invasion, Mr. Brown, who is said to have had serious reservations about the British commitment when the cabinet made its key decisions in March 2003, will be under pressure to explain why he subordinated his doubts and supported Mr. Blair. Earlier this year, the Brown government intervened to halt the publication of the minutes of cabinet meetings held just before the war started.
A key issue to be addressed by the inquiry will be the use — or abuse, as critics of the war have contended — of the pre-war intelligence provided by Britain’s security agencies, particularly MI6, the Secret Intelligence Service. The issue has already been examined twice by public inquiries, both of which broadly exonerated the government.
One inquiry was held into the death by apparent suicide in 2004 of Dr. David Kelly, one of Britain’s top weapons scientists, who told a BBC interviewer he believed the Blair government had overstated the intelligence on which it based its conclusions that Saddam Hussein had an arsenal of biological and chemical weapons that posed a ready-to-launch threat. A second inquiry into the Blair government’s use of intelligence in 2005 criticized intelligence officials for relying on flawed unreliable sources.
Another consideration weighing in favor of holding the inquiry behind closed doors, according to government officials, is the risk that public criticism of Britain’s military operations in Iraq will damaging the morale or combat effectiveness of the nearly 9,000 British troops fighting in Afghanistan, many of them from units that have seen combat in Iraq. The sensitivities of families who have lost relatives among the 179 British troops killed in Iraq — some of them in favor of an inquiry in public, others against — has been another factor.
LONDON — After years of delay, the British government said Monday it would go ahead with an inquiry into the country’s role in the Iraq war, an issue that has been deeply divisive ever since the former prime minister, Tony Blair, committed more than 40,000 troops to the invasion in 2003.
Britain’s combat role ended in April, and the last British troops are scheduled to withdraw from their base at the southern city of Basra by July 30, their role taken over by American troops. Prime Minister Gordon Brown, under pressure for an inquiry from his own Labor party and from the opposition Conservatives, has long insisted that the British role in the war should be ended first.
Mr. Brown was scheduled to make a statement on the inquiry in the House of Commons on Monday afternoon, but the decision to go ahead was confirmed by Michael Ellam, his spokesman at 10 Downing Street. Key issues to be settled by the prime minister include whether the inquiry will be held in public or in private, and whether it will review the political decisions that led to war, as well as the conduct of military operations.
Few issues in Britain have been as contentious in the past generation as the decision to join the United States in the 2003 invasion. The commitment took on the character of a personal mission for Mr. Blair, who prevailed over a divided cabinet and Britain’s largest street protests in decades in forging the war coalition with former American president, George W. Bush.
It was an improbable partnership, given the wide philosophical differences between Mr. Blair’s Labor party and the conservative Republicanism of Mr. Bush. It ended, for Mr. Blair, two years ago this month, when he was hastened from office after 10 years by a left-of-center cabal led by Mr. Brown, his successor as prime minister, whose campaign to oust Mr. Blair rested in large part with the party’s unreconciled opposition to the war.
Mr. Blair has gone on to become a Middle East peace negotiator and a highly paid adviser to international banks, as well as a much-sought-after public speaker, particularly in the United States. He is said to have amassed a personal fortune of about $32 million. Mr. Brown, meanwhile, has seen Labor’s political fortunes plunge for reasons not related to the Iraq war, and narrowly survived a cabinet revolt earlier this month that threatened to unseat him.
He has had to tread warily in ordering a formal war inquiry. If the probe examines the political decision-making that preceded the invasion, Mr. Brown, who is said to have had serious reservations about the British commitment when the cabinet made its key decisions in March 2003, will be under pressure to explain why he subordinated his doubts and supported Mr. Blair. Earlier this year, the Brown government intervened to halt the publication of the minutes of cabinet meetings held just before the war started.
A key issue to be addressed by the inquiry will be the use — or abuse, as critics of the war have contended — of the pre-war intelligence provided by Britain’s security agencies, particularly MI6, the Secret Intelligence Service. The issue has already been examined twice by public inquiries, both of which broadly exonerated the government.
One inquiry was held into the death by apparent suicide in 2004 of Dr. David Kelly, one of Britain’s top weapons scientists, who told a BBC interviewer he believed the Blair government had overstated the intelligence on which it based its conclusions that Saddam Hussein had an arsenal of biological and chemical weapons that posed a ready-to-launch threat. A second inquiry into the Blair government’s use of intelligence in 2005 criticized intelligence officials for relying on flawed unreliable sources.
Another consideration weighing in favor of holding the inquiry behind closed doors, according to government officials, is the risk that public criticism of Britain’s military operations in Iraq will damaging the morale or combat effectiveness of the nearly 9,000 British troops fighting in Afghanistan, many of them from units that have seen combat in Iraq. The sensitivities of families who have lost relatives among the 179 British troops killed in Iraq — some of them in favor of an inquiry in public, others against — has been another factor.
Obama Pleads for Support of Health System Overhaul
CHICAGO (AP) -- President Barack Obama has made another strong pitch for overhauling the U.S. health care system, calling it ''a ticking bomb for the federal budget.''
Obama went before the American Medical Association in Chicago Monday to declare that the existing system leaves too many uninsured and forces ''excessive defensive medicine'' by doctors worried about malpractice suits.
Obama told his audience he is open to requiring all Americans to have health insurance. But he emphasized that the plan he envisions would permit continuing help for those who cannot afford it on their own. Obama said a ''health care exchange'' would be set up for the uninsured to choose a plan.
Without such change, Obama said the U.S. economy could end up in the same shape as the failed General Motors Corporation and Chrysler.
THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.
WASHINGTON (AP) -- President Barack Obama, continuing to barnstorm for his health care proposals, will urge doctors gathered in Chicago to support wider insurance coverage and targeted federal spending cuts.
Obama planned to tell the American Medical Association's annual meeting in his hometown on Monday that overhaul cannot wait and that bringing down costs is the most important thing he can do to ensure the country's long-term fiscal health, a senior administration official said.
The official spoke on the condition of anonymity to discuss the president's remarks before they were delivered.
The nation's doctors, like many other groups, are divided over the president's proposals to reshape the health care delivery system. The White House anticipates heavy spending to cover the almost 50 million Americans who lack health insurance and has taken steps in recent days to outline just where that money could be found.
For instance, Obama wants to cut federal payments to hospitals by about $200 billion and cut $313 billion from Medicare and Medicaid over 10 years. He also is proposing a $635 billion ''down payment'' in tax increases and spending cuts in the health care system.
To an audience of doctors Obama plans to say the United States spends too much on health care and gets too little in return. He says the health industry is crushing businesses and families and is leading to millions of Americans losing coverage, the administration official said.
Obama's turn before the 250,000-physician group in his latest effort to persuade skeptics that his goal to provide health care to all Americans is worth the $1 trillion price tag it is expected to run during its first decade.
The president plans to acknowledge the costs. But he also will tell the doctors it is not acceptable for the nation to leave so many without insurance, the official said.
Unified Republicans and some fiscally conservative Democrats on Capitol Hill have said they are nervous about how the administration plans to pay for Obama's ideas.
There have been indications Obama has been quietly making a case for reducing malpractice lawsuits to help control costs, long a goal of the AMA and Republicans. Obama has not endorsed capping jury awards
Former Senate Majority Leader Tom Daschle, D-S.D., said Monday that controlling the cost of malpractice insurance would have to be a part of the Obama administration's overhaul of the health care system.
Daschle, whose nomination for secretary of health and human resources was derailed because of questions about his personal finances, said much of the unnecessary annual health care cost can be attributed to doctors ordering extra tests and taking extra precautions to make sure ''they aren't sued.''
Obama has been speaking privately with lawmakers about his ideas and publicly with audiences, such as a town hall style meeting last week in Green Bay, Wis. Obama and his administration officials have blanketed the nation in support of his broad ideas, and Vice President Joe Biden on Sunday said it's up to Congress to pin down the details on how to pay for them.
''They're either going to have to agree with us, come up with an alternative or we're not going to have health care,'' Biden told NBC's ''Meet the Press.''
''And we're going to get health care.''
In Chicago, the president's remarks are likely to focus on how his ideas might affect the medical profession.
His proposed cuts in federal payments would hit hospitals more directly than doctors, but physicians will be affected by virtually every change that Congress eventually agrees to. Many medical professionals are not yet convinced Obama's overhaul is the best for their care or their pocketbooks.
Broadly, the AMA supports a health care ''reform'' -- a term that changes its definition based on who is speaking -- although the specifics remain unclear.
In a statement welcoming Obama, AMA president Dr. Nancy Nielsen said the medical profession wants to ''reduce unnecessary costs by focusing on quality improvements, such as developing best practices for care and improving medication reconciliation.''
She also said doctors need greater protection from malpractice lawsuits and antitrust restrictions.
Many congressional Republicans, insurance groups and others oppose Obama's bid for a government-run health insurance program that would compete with private companies. On Sunday, Senate Minority Leader Mitch McConnell, R-Ky., described a government plan as a ''nonstarter.''
''There are a whole lot of other things we can agree to do on a bipartisan basis that will dramatically improve our system,'' he said.
To that end, lawmakers were considering a possible compromise that involved a cooperative program that would enjoy taxpayer support without direct governmental control. The concessions could be the smoothest way to deliver the bipartisan health care legislation the administration seeks by its self-imposed August deadline, officials said.
''There is no one-size-fits-all idea,'' Health and Human Services Secretary Kathleen Sebelius told CNN's ''State of the Union'' on Sunday.
''The president has said, 'These are the kinds of goals I'm after: lowering costs, covering all Americans, higher-quality care.' And around those goals, there are lots of ways to get there.''
Momentum might be on Obama's side. Aaron Carroll, an Indiana University medical professor who has surveyed doctors' views on U.S. health care delivery, said 59 percent ''favor government legislation to establish national health insurance,'' an increase over a previous poll's finding.
He noted that many doctors are not AMA members, and therefore the association's views should not be overrated.
Obama went before the American Medical Association in Chicago Monday to declare that the existing system leaves too many uninsured and forces ''excessive defensive medicine'' by doctors worried about malpractice suits.
Obama told his audience he is open to requiring all Americans to have health insurance. But he emphasized that the plan he envisions would permit continuing help for those who cannot afford it on their own. Obama said a ''health care exchange'' would be set up for the uninsured to choose a plan.
Without such change, Obama said the U.S. economy could end up in the same shape as the failed General Motors Corporation and Chrysler.
THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.
WASHINGTON (AP) -- President Barack Obama, continuing to barnstorm for his health care proposals, will urge doctors gathered in Chicago to support wider insurance coverage and targeted federal spending cuts.
Obama planned to tell the American Medical Association's annual meeting in his hometown on Monday that overhaul cannot wait and that bringing down costs is the most important thing he can do to ensure the country's long-term fiscal health, a senior administration official said.
The official spoke on the condition of anonymity to discuss the president's remarks before they were delivered.
The nation's doctors, like many other groups, are divided over the president's proposals to reshape the health care delivery system. The White House anticipates heavy spending to cover the almost 50 million Americans who lack health insurance and has taken steps in recent days to outline just where that money could be found.
For instance, Obama wants to cut federal payments to hospitals by about $200 billion and cut $313 billion from Medicare and Medicaid over 10 years. He also is proposing a $635 billion ''down payment'' in tax increases and spending cuts in the health care system.
To an audience of doctors Obama plans to say the United States spends too much on health care and gets too little in return. He says the health industry is crushing businesses and families and is leading to millions of Americans losing coverage, the administration official said.
Obama's turn before the 250,000-physician group in his latest effort to persuade skeptics that his goal to provide health care to all Americans is worth the $1 trillion price tag it is expected to run during its first decade.
The president plans to acknowledge the costs. But he also will tell the doctors it is not acceptable for the nation to leave so many without insurance, the official said.
Unified Republicans and some fiscally conservative Democrats on Capitol Hill have said they are nervous about how the administration plans to pay for Obama's ideas.
There have been indications Obama has been quietly making a case for reducing malpractice lawsuits to help control costs, long a goal of the AMA and Republicans. Obama has not endorsed capping jury awards
Former Senate Majority Leader Tom Daschle, D-S.D., said Monday that controlling the cost of malpractice insurance would have to be a part of the Obama administration's overhaul of the health care system.
Daschle, whose nomination for secretary of health and human resources was derailed because of questions about his personal finances, said much of the unnecessary annual health care cost can be attributed to doctors ordering extra tests and taking extra precautions to make sure ''they aren't sued.''
Obama has been speaking privately with lawmakers about his ideas and publicly with audiences, such as a town hall style meeting last week in Green Bay, Wis. Obama and his administration officials have blanketed the nation in support of his broad ideas, and Vice President Joe Biden on Sunday said it's up to Congress to pin down the details on how to pay for them.
''They're either going to have to agree with us, come up with an alternative or we're not going to have health care,'' Biden told NBC's ''Meet the Press.''
''And we're going to get health care.''
In Chicago, the president's remarks are likely to focus on how his ideas might affect the medical profession.
His proposed cuts in federal payments would hit hospitals more directly than doctors, but physicians will be affected by virtually every change that Congress eventually agrees to. Many medical professionals are not yet convinced Obama's overhaul is the best for their care or their pocketbooks.
Broadly, the AMA supports a health care ''reform'' -- a term that changes its definition based on who is speaking -- although the specifics remain unclear.
In a statement welcoming Obama, AMA president Dr. Nancy Nielsen said the medical profession wants to ''reduce unnecessary costs by focusing on quality improvements, such as developing best practices for care and improving medication reconciliation.''
She also said doctors need greater protection from malpractice lawsuits and antitrust restrictions.
Many congressional Republicans, insurance groups and others oppose Obama's bid for a government-run health insurance program that would compete with private companies. On Sunday, Senate Minority Leader Mitch McConnell, R-Ky., described a government plan as a ''nonstarter.''
''There are a whole lot of other things we can agree to do on a bipartisan basis that will dramatically improve our system,'' he said.
To that end, lawmakers were considering a possible compromise that involved a cooperative program that would enjoy taxpayer support without direct governmental control. The concessions could be the smoothest way to deliver the bipartisan health care legislation the administration seeks by its self-imposed August deadline, officials said.
''There is no one-size-fits-all idea,'' Health and Human Services Secretary Kathleen Sebelius told CNN's ''State of the Union'' on Sunday.
''The president has said, 'These are the kinds of goals I'm after: lowering costs, covering all Americans, higher-quality care.' And around those goals, there are lots of ways to get there.''
Momentum might be on Obama's side. Aaron Carroll, an Indiana University medical professor who has surveyed doctors' views on U.S. health care delivery, said 59 percent ''favor government legislation to establish national health insurance,'' an increase over a previous poll's finding.
He noted that many doctors are not AMA members, and therefore the association's views should not be overrated.
Sunday, June 14, 2009
Stay the Course By PAUL KRUGMAN
The debate over economic policy has taken a predictable yet ominous turn: the crisis seems to be easing, and a chorus of critics is already demanding that the Federal Reserve and the Obama administration abandon their rescue efforts. For those who know their history, it’s déjà vu all over again — literally.
For this is the third time in history that a major economy has found itself in a liquidity trap, a situation in which interest-rate cuts, the conventional way to perk up the economy, have reached their limit. When this happens, unconventional measures are the only way to fight recession.
Yet such unconventional measures make the conventionally minded uncomfortable, and they keep pushing for a return to normalcy. In previous liquidity-trap episodes, policy makers gave in to these pressures far too soon, plunging the economy back into crisis. And if the critics have their way, we’ll do the same thing this time.
The first example of policy in a liquidity trap comes from the 1930s. The U.S. economy grew rapidly from 1933 to 1937, helped along by New Deal policies. America, however, remained well short of full employment.
Yet policy makers stopped worrying about depression and started worrying about inflation. The Federal Reserve tightened monetary policy, while F.D.R. tried to balance the federal budget. Sure enough, the economy slumped again, and full recovery had to wait for World War II.
The second example is Japan in the 1990s. After slumping early in the decade, Japan experienced a partial recovery, with the economy growing almost 3 percent in 1996. Policy makers responded by shifting their focus to the budget deficit, raising taxes and cutting spending. Japan proceeded to slide back into recession.
And here we go again.
On one side, the inflation worriers are harassing the Fed. The latest example: Arthur Laffer, he of the curve, warns that the Fed’s policies will cause devastating inflation. He recommends, among other things, possibly raising banks’ reserve requirements, which happens to be exactly what the Fed did in 1936 and 1937 — a move that none other than Milton Friedman condemned as helping to strangle economic recovery.
Meanwhile, there are demands from several directions that President Obama’s fiscal stimulus plan be canceled.
Some, especially in Europe, argue that stimulus isn’t needed, because the economy is already turning around.
Others claim that government borrowing is driving up interest rates, and that this will derail recovery.
And Republicans, providing a bit of comic relief, are saying that the stimulus has failed, because the enabling legislation was passed four months ago — wow, four whole months! — yet unemployment is still rising. This suggests an interesting comparison with the economic record of Ronald Reagan, whose 1981 tax cut was followed by no less than 16 months of rising unemployment.
O.K., time for some reality checks.
First of all, while stock markets have been celebrating the economy’s “green shoots,” the fact is that unemployment is very high and still rising. That is, we’re not even experiencing the kind of growth that led to the big mistakes of 1937 and 1997. It’s way too soon to declare victory.
What about the claim that the Fed is risking inflation? It isn’t. Mr. Laffer seems panicked by a rapid rise in the monetary base, the sum of currency in circulation and the reserves of banks. But a rising monetary base isn’t inflationary when you’re in a liquidity trap. America’s monetary base doubled between 1929 and 1939; prices fell 19 percent. Japan’s monetary base rose 85 percent between 1997 and 2003; deflation continued apace.
Well then, what about all that government borrowing? All it’s doing is offsetting a plunge in private borrowing — total borrowing is down, not up. Indeed, if the government weren’t running a big deficit right now, the economy would probably be well on its way to a full-fledged depression.
Oh, and investors’ growing confidence that we’ll manage to avoid a full-fledged depression — not the pressure of government borrowing — explains the recent rise in long-term interest rates. These rates, by the way, are still low by historical standards. They’re just not as low as they were at the peak of the panic, earlier this year.
To sum up: A few months ago the U.S. economy was in danger of falling into depression. Aggressive monetary policy and deficit spending have, for the time being, averted that danger. And suddenly critics are demanding that we call the whole thing off, and revert to business as usual.
Those demands should be ignored. It’s much too soon to give up on policies that have, at most, pulled us a few inches back from the edge of the abyss.
For this is the third time in history that a major economy has found itself in a liquidity trap, a situation in which interest-rate cuts, the conventional way to perk up the economy, have reached their limit. When this happens, unconventional measures are the only way to fight recession.
Yet such unconventional measures make the conventionally minded uncomfortable, and they keep pushing for a return to normalcy. In previous liquidity-trap episodes, policy makers gave in to these pressures far too soon, plunging the economy back into crisis. And if the critics have their way, we’ll do the same thing this time.
The first example of policy in a liquidity trap comes from the 1930s. The U.S. economy grew rapidly from 1933 to 1937, helped along by New Deal policies. America, however, remained well short of full employment.
Yet policy makers stopped worrying about depression and started worrying about inflation. The Federal Reserve tightened monetary policy, while F.D.R. tried to balance the federal budget. Sure enough, the economy slumped again, and full recovery had to wait for World War II.
The second example is Japan in the 1990s. After slumping early in the decade, Japan experienced a partial recovery, with the economy growing almost 3 percent in 1996. Policy makers responded by shifting their focus to the budget deficit, raising taxes and cutting spending. Japan proceeded to slide back into recession.
And here we go again.
On one side, the inflation worriers are harassing the Fed. The latest example: Arthur Laffer, he of the curve, warns that the Fed’s policies will cause devastating inflation. He recommends, among other things, possibly raising banks’ reserve requirements, which happens to be exactly what the Fed did in 1936 and 1937 — a move that none other than Milton Friedman condemned as helping to strangle economic recovery.
Meanwhile, there are demands from several directions that President Obama’s fiscal stimulus plan be canceled.
Some, especially in Europe, argue that stimulus isn’t needed, because the economy is already turning around.
Others claim that government borrowing is driving up interest rates, and that this will derail recovery.
And Republicans, providing a bit of comic relief, are saying that the stimulus has failed, because the enabling legislation was passed four months ago — wow, four whole months! — yet unemployment is still rising. This suggests an interesting comparison with the economic record of Ronald Reagan, whose 1981 tax cut was followed by no less than 16 months of rising unemployment.
O.K., time for some reality checks.
First of all, while stock markets have been celebrating the economy’s “green shoots,” the fact is that unemployment is very high and still rising. That is, we’re not even experiencing the kind of growth that led to the big mistakes of 1937 and 1997. It’s way too soon to declare victory.
What about the claim that the Fed is risking inflation? It isn’t. Mr. Laffer seems panicked by a rapid rise in the monetary base, the sum of currency in circulation and the reserves of banks. But a rising monetary base isn’t inflationary when you’re in a liquidity trap. America’s monetary base doubled between 1929 and 1939; prices fell 19 percent. Japan’s monetary base rose 85 percent between 1997 and 2003; deflation continued apace.
Well then, what about all that government borrowing? All it’s doing is offsetting a plunge in private borrowing — total borrowing is down, not up. Indeed, if the government weren’t running a big deficit right now, the economy would probably be well on its way to a full-fledged depression.
Oh, and investors’ growing confidence that we’ll manage to avoid a full-fledged depression — not the pressure of government borrowing — explains the recent rise in long-term interest rates. These rates, by the way, are still low by historical standards. They’re just not as low as they were at the peak of the panic, earlier this year.
To sum up: A few months ago the U.S. economy was in danger of falling into depression. Aggressive monetary policy and deficit spending have, for the time being, averted that danger. And suddenly critics are demanding that we call the whole thing off, and revert to business as usual.
Those demands should be ignored. It’s much too soon to give up on policies that have, at most, pulled us a few inches back from the edge of the abyss.
Saturday, June 13, 2009
FRANK RICH The Obama Haters’ Silent Enablers
WHEN a Fox News anchor, reacting to his own network’s surging e-mail traffic, warns urgently on-camera of a rise in hate-filled, “amped up” Americans who are “taking the extra step and getting the gun out,” maybe we should listen. He has better sources in that underground than most.
The anchor was Shepard Smith, speaking after Wednesday’s mayhem at the United States Holocaust Memorial Museum in Washington. Unlike the bloviators at his network and elsewhere on cable, Smith is famous for his highly caffeinated news-reading, not any political agenda. But very occasionally — notably during Hurricane Katrina — he hits the Howard Beale mad-as-hell wall. Joining those at Fox who routinely disregard the network’s “We report, you decide” mantra, he both reported and decided, loudly.
What he reported was this: his e-mail from viewers had “become more and more frightening” in recent months, dating back to the election season. From Wednesday alone, he “could read a hundred” messages spewing “hate that’s not based in fact,” much of it about Barack Obama and some of it sharing the museum gunman’s canard that the president was not a naturally born citizen. These are Americans “out there in a scary place,” Smith said.
Then he brought up another recent gunman: “If you’re one who believes that abortion is murder, at what point do you go out and kill someone who’s performing abortions?” An answer, he said, was provided by Dr. George Tiller’s killer. He went on: “If you are one who believes these sorts of things about the president of the United States ...” He left the rest of that chilling sentence unsaid.
These are extraordinary words to hear on Fox. The network’s highest-rated star, Bill O’Reilly, had assailed Tiller, calling him “Tiller the baby killer” and likening him to the Nazis, on 29 of his shows before the doctor was murdered at his church in Kansas. O’Reilly was unrepentant, stating that only “pro-abortion zealots and Fox News haters” would link him to the crime. But now another Fox star, while stopping short of blaming O’Reilly, was breaching his network’s brand of political correctness: he tied the far-right loners who had gotten their guns out in Wichita and Washington to the mounting fury of Obama haters.
What is this fury about? In his scant 145 days in office, the new president has not remotely matched the Bush record in deficit creation. Nor has he repealed the right to bear arms or exacerbated the wars he inherited. He has tried more than his predecessor ever did to reach across the aisle. But none of that seems to matter. A sizable minority of Americans is irrationally fearful of the fast-moving generational, cultural and racial turnover Obama embodies — indeed, of the 21st century itself. That minority is now getting angrier in inverse relationship to his popularity with the vast majority of the country. Change can be frightening and traumatic, especially if it’s not change you can believe in.
We don’t know whether the tiny subset of domestic terrorists in this crowd is egged on by political or media demagogues — though we do tend to assume that foreign jihadists respond like Pavlov’s dogs to the words of their most fanatical leaders and polemicists. But well before the latest murderers struck — well before another “antigovernment” Obama hater went on a cop-killing rampage in Pittsburgh in April — there have been indications that this rage could spiral out of control.
This was evident during the campaign, when hotheads greeted Obama’s name with “Treason!” and “Terrorist!” at G.O.P. rallies. At first the McCain-Palin campaign fed the anger with accusations that Obama was “palling around with terrorists.” But later John McCain thought better of it and defended his opponent’s honor to a town-hall participant who vented her fears of the Democrats’ “Arab” candidate. Although two neo-Nazi skinheads were arrested in an assassination plot against Obama two weeks before Election Day, the fever broke after McCain exercised leadership.
That honeymoon, if it was one, is over. Conservatives have legitimate ideological beefs with Obama, rightly expressed in sharp language. But the invective in some quarters has unmistakably amped up. The writer Camille Paglia, a political independent and confessed talk-radio fan, detected a shift toward paranoia in the air waves by mid-May. When “the tone darkens toward a rhetoric of purgation and annihilation,” she observed in Salon, “there is reason for alarm.” She cited a “joke” repeated by a Rush Limbaugh fill-in host, a talk-radio jock from Dallas of all places, about how “any U.S. soldier” who found himself with only two bullets in an elevator with Nancy Pelosi, Harry Reid and Osama bin Laden would use both shots to assassinate Pelosi and then strangle Reid and bin Laden.
This homicide-saturated vituperation is endemic among mini-Limbaughs. Glenn Beck has dipped into O’Reilly’s Holocaust analogies to liken Obama’s policy on stem-cell research to the eugenics that led to “the final solution” and the quest for “a master race.” After James von Brunn’s rampage at the Holocaust museum, Beck rushed onto Fox News to describe the Obama-hating killer as a “lone gunman nutjob.” Yet in the same show Beck also said von Brunn was a symptom that “the pot in America is boiling,” as if Beck himself were not the boiling pot cheering the kettle on.
But hyperbole from the usual suspects in the entertainment arena of TV and radio is not the whole story. What’s startling is the spillover of this poison into the conservative political establishment. Saul Anuzis, a former Michigan G.O.P. chairman who ran for the party’s national chairmanship this year, seriously suggested in April that Republicans should stop calling Obama a socialist because “it no longer has the negative connotation it had 20 years ago, or even 10 years ago.” Anuzis pushed “fascism” instead, because “everybody still thinks that’s a bad thing.” He didn’t seem to grasp that “fascism” is nonsensical as a description of the Obama administration or that there might be a risk in slurring a president with a word that most find “bad” because it evokes a mass-murderer like Hitler.
The Anuzis “fascism” solution to the Obama problem has caught fire. The president’s nomination of Sonia Sotomayor to the Supreme Court and his speech in Cairo have only exacerbated the ugliness. The venomous personal attacks on Sotomayor have little to do with the 3,000-plus cases she’s adjudicated in nearly 17 years on the bench or her thoughts about the judgment of “a wise Latina woman.” She has been tarred as a member of “the Latino KKK” (by the former Republican presidential candidate Tom Tancredo), as well as a racist and a David Duke (by Limbaugh), and portrayed, in a bizarre two-for-one ethnic caricature, as a slant-eyed Asian on the cover of National Review. Uniting all these insults is an aggrieved note of white victimization only a shade less explicit than that in von Brunn’s white supremacist screeds.
Obama’s Cairo address, meanwhile, prompted over-the-top accusations reminiscent of those campaign rally cries of “Treason!” It was a prominent former Reagan defense official, Frank Gaffney, not some fringe crackpot, who accused Obama in The Washington Times of engaging “in the most consequential bait-and-switch since Adolf Hitler duped Neville Chamberlain.” He claimed that the president — a lifelong Christian — “may still be” a Muslim and is aligned with “the dangerous global movement known as the Muslim Brotherhood.” Gaffney linked Obama by innuendo with Islamic “charities” that “have been convicted of providing material support for terrorism.”
If this isn’t a handy rationalization for another lone nutjob to take the law into his own hands against a supposed terrorism supporter, what is? Any such nutjob can easily grab a weapon. Gun enthusiasts have been on a shopping spree since the election, with some areas of our country reporting percentage sales increases in the mid-to-high double digits, recession be damned.
The question, Shepard Smith said on Fox last week, is “if there is really a way to put a hold on” those who might run amok. We’re not about to repeal the First or Second Amendments. Hard-core haters resolutely dismiss any “mainstream media” debunking of their conspiracy theories. The only voices that might penetrate their alternative reality — I emphasize might — belong to conservative leaders with the guts and clout to step up as McCain did last fall. Where are they? The genteel public debate in right-leaning intellectual circles about the conservative movement’s future will be buried by history if these insistent alarms are met with silence.
It’s typical of this dereliction of responsibility that when the Department of Homeland Security released a plausible (and, tragically, prescient) report about far-right domestic terrorism two months ago, the conservative response was to trash it as “the height of insult,” in the words of the G.O.P. chairman Michael Steele. But as Smith also said last week, Homeland Security was “warning us for a reason.”
No matter. Last week it was business as usual, as Republican leaders nattered ad infinitum over the juvenile rivalry of Sarah Palin and Newt Gingrich at the party’s big Washington fund-raiser. Few if any mentioned, let alone questioned, the ominous script delivered by the actor Jon Voight with the G.O.P. imprimatur at that same event. Voight’s devout wish was to “bring an end to this false prophet Obama.”
This kind of rhetoric, with its pseudo-Scriptural call to action, is toxic. It is getting louder each day of the Obama presidency. No one, not even Fox News viewers, can say they weren’t warned.
The anchor was Shepard Smith, speaking after Wednesday’s mayhem at the United States Holocaust Memorial Museum in Washington. Unlike the bloviators at his network and elsewhere on cable, Smith is famous for his highly caffeinated news-reading, not any political agenda. But very occasionally — notably during Hurricane Katrina — he hits the Howard Beale mad-as-hell wall. Joining those at Fox who routinely disregard the network’s “We report, you decide” mantra, he both reported and decided, loudly.
What he reported was this: his e-mail from viewers had “become more and more frightening” in recent months, dating back to the election season. From Wednesday alone, he “could read a hundred” messages spewing “hate that’s not based in fact,” much of it about Barack Obama and some of it sharing the museum gunman’s canard that the president was not a naturally born citizen. These are Americans “out there in a scary place,” Smith said.
Then he brought up another recent gunman: “If you’re one who believes that abortion is murder, at what point do you go out and kill someone who’s performing abortions?” An answer, he said, was provided by Dr. George Tiller’s killer. He went on: “If you are one who believes these sorts of things about the president of the United States ...” He left the rest of that chilling sentence unsaid.
These are extraordinary words to hear on Fox. The network’s highest-rated star, Bill O’Reilly, had assailed Tiller, calling him “Tiller the baby killer” and likening him to the Nazis, on 29 of his shows before the doctor was murdered at his church in Kansas. O’Reilly was unrepentant, stating that only “pro-abortion zealots and Fox News haters” would link him to the crime. But now another Fox star, while stopping short of blaming O’Reilly, was breaching his network’s brand of political correctness: he tied the far-right loners who had gotten their guns out in Wichita and Washington to the mounting fury of Obama haters.
What is this fury about? In his scant 145 days in office, the new president has not remotely matched the Bush record in deficit creation. Nor has he repealed the right to bear arms or exacerbated the wars he inherited. He has tried more than his predecessor ever did to reach across the aisle. But none of that seems to matter. A sizable minority of Americans is irrationally fearful of the fast-moving generational, cultural and racial turnover Obama embodies — indeed, of the 21st century itself. That minority is now getting angrier in inverse relationship to his popularity with the vast majority of the country. Change can be frightening and traumatic, especially if it’s not change you can believe in.
We don’t know whether the tiny subset of domestic terrorists in this crowd is egged on by political or media demagogues — though we do tend to assume that foreign jihadists respond like Pavlov’s dogs to the words of their most fanatical leaders and polemicists. But well before the latest murderers struck — well before another “antigovernment” Obama hater went on a cop-killing rampage in Pittsburgh in April — there have been indications that this rage could spiral out of control.
This was evident during the campaign, when hotheads greeted Obama’s name with “Treason!” and “Terrorist!” at G.O.P. rallies. At first the McCain-Palin campaign fed the anger with accusations that Obama was “palling around with terrorists.” But later John McCain thought better of it and defended his opponent’s honor to a town-hall participant who vented her fears of the Democrats’ “Arab” candidate. Although two neo-Nazi skinheads were arrested in an assassination plot against Obama two weeks before Election Day, the fever broke after McCain exercised leadership.
That honeymoon, if it was one, is over. Conservatives have legitimate ideological beefs with Obama, rightly expressed in sharp language. But the invective in some quarters has unmistakably amped up. The writer Camille Paglia, a political independent and confessed talk-radio fan, detected a shift toward paranoia in the air waves by mid-May. When “the tone darkens toward a rhetoric of purgation and annihilation,” she observed in Salon, “there is reason for alarm.” She cited a “joke” repeated by a Rush Limbaugh fill-in host, a talk-radio jock from Dallas of all places, about how “any U.S. soldier” who found himself with only two bullets in an elevator with Nancy Pelosi, Harry Reid and Osama bin Laden would use both shots to assassinate Pelosi and then strangle Reid and bin Laden.
This homicide-saturated vituperation is endemic among mini-Limbaughs. Glenn Beck has dipped into O’Reilly’s Holocaust analogies to liken Obama’s policy on stem-cell research to the eugenics that led to “the final solution” and the quest for “a master race.” After James von Brunn’s rampage at the Holocaust museum, Beck rushed onto Fox News to describe the Obama-hating killer as a “lone gunman nutjob.” Yet in the same show Beck also said von Brunn was a symptom that “the pot in America is boiling,” as if Beck himself were not the boiling pot cheering the kettle on.
But hyperbole from the usual suspects in the entertainment arena of TV and radio is not the whole story. What’s startling is the spillover of this poison into the conservative political establishment. Saul Anuzis, a former Michigan G.O.P. chairman who ran for the party’s national chairmanship this year, seriously suggested in April that Republicans should stop calling Obama a socialist because “it no longer has the negative connotation it had 20 years ago, or even 10 years ago.” Anuzis pushed “fascism” instead, because “everybody still thinks that’s a bad thing.” He didn’t seem to grasp that “fascism” is nonsensical as a description of the Obama administration or that there might be a risk in slurring a president with a word that most find “bad” because it evokes a mass-murderer like Hitler.
The Anuzis “fascism” solution to the Obama problem has caught fire. The president’s nomination of Sonia Sotomayor to the Supreme Court and his speech in Cairo have only exacerbated the ugliness. The venomous personal attacks on Sotomayor have little to do with the 3,000-plus cases she’s adjudicated in nearly 17 years on the bench or her thoughts about the judgment of “a wise Latina woman.” She has been tarred as a member of “the Latino KKK” (by the former Republican presidential candidate Tom Tancredo), as well as a racist and a David Duke (by Limbaugh), and portrayed, in a bizarre two-for-one ethnic caricature, as a slant-eyed Asian on the cover of National Review. Uniting all these insults is an aggrieved note of white victimization only a shade less explicit than that in von Brunn’s white supremacist screeds.
Obama’s Cairo address, meanwhile, prompted over-the-top accusations reminiscent of those campaign rally cries of “Treason!” It was a prominent former Reagan defense official, Frank Gaffney, not some fringe crackpot, who accused Obama in The Washington Times of engaging “in the most consequential bait-and-switch since Adolf Hitler duped Neville Chamberlain.” He claimed that the president — a lifelong Christian — “may still be” a Muslim and is aligned with “the dangerous global movement known as the Muslim Brotherhood.” Gaffney linked Obama by innuendo with Islamic “charities” that “have been convicted of providing material support for terrorism.”
If this isn’t a handy rationalization for another lone nutjob to take the law into his own hands against a supposed terrorism supporter, what is? Any such nutjob can easily grab a weapon. Gun enthusiasts have been on a shopping spree since the election, with some areas of our country reporting percentage sales increases in the mid-to-high double digits, recession be damned.
The question, Shepard Smith said on Fox last week, is “if there is really a way to put a hold on” those who might run amok. We’re not about to repeal the First or Second Amendments. Hard-core haters resolutely dismiss any “mainstream media” debunking of their conspiracy theories. The only voices that might penetrate their alternative reality — I emphasize might — belong to conservative leaders with the guts and clout to step up as McCain did last fall. Where are they? The genteel public debate in right-leaning intellectual circles about the conservative movement’s future will be buried by history if these insistent alarms are met with silence.
It’s typical of this dereliction of responsibility that when the Department of Homeland Security released a plausible (and, tragically, prescient) report about far-right domestic terrorism two months ago, the conservative response was to trash it as “the height of insult,” in the words of the G.O.P. chairman Michael Steele. But as Smith also said last week, Homeland Security was “warning us for a reason.”
No matter. Last week it was business as usual, as Republican leaders nattered ad infinitum over the juvenile rivalry of Sarah Palin and Newt Gingrich at the party’s big Washington fund-raiser. Few if any mentioned, let alone questioned, the ominous script delivered by the actor Jon Voight with the G.O.P. imprimatur at that same event. Voight’s devout wish was to “bring an end to this false prophet Obama.”
This kind of rhetoric, with its pseudo-Scriptural call to action, is toxic. It is getting louder each day of the Obama presidency. No one, not even Fox News viewers, can say they weren’t warned.
MEDIA MATTERS 'Week' on RIGHT WING WACKOS
Right-wing media and the fringe:
A growing history of violence (and denial)
6-12/09
This week, the country's attention was captured by the horrific shooting at the U.S. Holocaust Memorial Museum, allegedly by James W. von Brunn, an 88-year-old man with ties to white supremacist and anti-Semitic organizations. The fatal shooting came just two months after an April 7 Department of Homeland Security report detailing potential increases in right-wing extremism.
As Media Matters for America documented, the DHS report was immediately and vehemently rejected by numerous conservative commentators, such as Lou Dobbs, Rush Limbaugh, Sean Hannity, Michelle Malkin, and David Asman, who portrayed it as an illegitimate and politically motivated assault on conservatives. (Media Matters Senior Fellow Karl Frisch puts the attacks in even broader perspective here.)
Following the Holocaust Memorial Museum attack, these commentators faced criticism for their earlier dismissiveness. Some have since unconvincingly (and in the case of Joe Scarborough, inaccurately) defended their past assessment, and a handful of reporters and analysts are still engaging in falsehoods and inconsistencies in criticizing the DHS report. But on Fox News, Shepard Smith took a different position -- for which he was attacked by conservatives -- saying that the report "was a warning to us all. And it appears now that they were right."
The day before the Holocaust Memorial Museum attack, Media Matters Senior Fellow Eric Boehlert wrote that Fox News and its hosts "will have more right-wing vigilantism to explain." He added that "militia-style vigilante rhetoric has become a cornerstone of the conservative media movement in America, and it's now proudly championed by Fox News on a nearly hourly basis." (He also appeared on CNN this week.)
While right-wing media are certainly not legally culpable for any recent attacks, they are responsible for promoting a culture of fear, paranoia, and violence that is anti-government in the extreme -- a culture in which extremists, including von Brunn and Richard Poplawski, who fatally shot three Pittsburgh police officers, were apparently immersed. Poplawski was convinced that the Obama administration was going to take away his guns. Even though no evidence of such a policy exists, right-wing commentators and news organizations made the claim repeatedly before the shooting and have continued to do so since.
Predictably, conservative media figures responded to the museum shooting by attempting to shift attention away from themselves and onto political liberals and even President Obama himself. On June 10, the day of the museum shooting, financial analyst and radio host Jim Lacamp said on Fox News that "we have an administration that's really done a lot of class warfare, a lot of class-baiting. And so, it sets the stage for social unrest." That same day, conservative Tammy Bruce wrote that the Obama administration's "increasing anti-Israel rhetoric and the pandering to the Jew-hating world Arab world ... encourages all the beasts among us." Newsmax.com published an op-ed, cited on Friday by Michael Savage, claiming that Obama "is most certainly creating a climate of hate against" Jews. Colorado radio host Bob Newman even raised questions about whether Obama's recent visit to a concentration camp, or his statement about Israeli settlements, were factors in the shooting.
But as always, the most virulent reality-denier was Rush Limbaugh. Limbaugh claimed that von Brunn "is a leftist if anything." He said that Obama is "ramping up hatred for Israel" and that "anti-Jew rhetoric comes from the American left." He claimed that MSNBC broadcasts "hate 24/7." Despite the right wing's repeated use of violent, revolutionary rhetoric, Limbaugh said that it was actually Obama who "thrives and needs chaos" to succeed. And in response to Shepard Smith, he remarked that the "claim that the atmosphere is somehow more violently anti-Obama is simply preposterous."
Indeed, Smith's remarks were the exception for the right. Despite its love of fearmongering, Fox News spent the 24 hours after the von Brunn shooting downplaying it. And on his broadcast that night, Bill O'Reilly, who hypocritically and incorrectly criticized the media for a supposed lack of coverage after the shooting death of Army recruiter Pvt. William Long, and who stokes the anger of viewers whenever it suits him politically, barely mentioned the shooting and instead featured what he called a "very important story" on gay penguins. "Do they wear tight T-shirts?" he asked, laughing. During the two shows after the shooting, Hannity barely mentioned it.
Other major stories this week:
Newt in the news
This was a big week for former House Speaker Newt Gingrich, who is clearly attempting to position himself as the new (aka, old) voice of the GOP. (And according to USA Today, he's in the running.)
Newt, who had previously backed off of referring to Judge Sonia Sotomayor as a "racist," began the week by modifying his argument and repeating the dubious claim that she "clearly supported racial quotas" in the Frank Ricci case.
He followed it up at a congressional Republican fundraiser by proudly declaring that he was "not a citizen of the world," saying that "the entire concept is intellectual nonsense and stunningly dangerous." CNN's Candy Crowley and CQ Politics' Jonathan Allen reported Gingrich's statement without noting that President Ronald Reagan made similar remarks while addressing the United Nations in 1982. (You would think that Gingrich, a former history teacher, would have known better.) After Media Matters documented the oversight, MSNBC's David Shuster and Keith Olbermann, as well as by NBC's Brian Williams, subjected Gingrich's remarks to scrutiny.
Newt closed the week by reacting to a Weekly Standard article discussing the ongoing U.S. practice of reading Miranda rights to detainees. On Fox News' Hannity, Gingrich said that it was "unimaginable. It's worse than anything Jimmy Carter ever did. It's worse than anything that President Bill Clinton ever did." In doing so, he ignored the part of the article reporting that the FBI also Mirandized people at "specific bases" during the Bush administration.
Newt's factually challenged analysis has come to be so legendary that even MSNBC's Mike Barnicle felt compelled to ask, "[W]hy would anyone pay attention to anything he says?" It's a good question. Perhaps it's because networks like Fox News do whatever they can to make Gingrich, who hasn't held any office or official position since 1998, relevant.
Health care reform is coming, and the news is already making me sick
All three national networks covered a Thursday town hall meeting that Obama held in Wisconsin, during which he laid out his health care proposals in detail. And yet, not one of them reported on the substance of his remarks, focusing instead on a note he wrote for a 10-year-old girl who was skipping school.
On Friday, NPR's Mara Liasson claimed that the American Medical Association opposes a public plan as a component of health care reform, even though the AMA had backtracked the same day, stating that it was "willing to consider other variations of a public plan that are currently under discussion in Congress." Flaws in a New York Times story the day before about the AMA's position were the subject of Media Matters Senior Fellow Jamison Foser's column this week.
And during a Wednesday interview with Pennsylvania Sen. Bob Casey, MSNBC's Norah O'Donnell freely editorialized, lecturing him on how current proposals seemingly would "drive the deficit into these stratospheric numbers" and complaining that senators were engaging in "gobbledygook" on the issue.
The need for accurate and impartial reporting on impending legislation is made all the more acute by the long history and prevalence of misinformation from media conservatives on the issue. On Thursday, Limbaugh began pulling out the stops, sounding not unlike O'Donnell in the process. "And it's all about control," he said. "It's not about cost. This man's not worried about the cost of anything. He doesn't care what anything costs: a trip to New York for a date -- $12 trillion in debt over 10 years? He doesn't care what things cost." He went on to hypothesize that "exercise freaks ... are the ones putting stress on the health care system" because they keep getting injured.
Buchanan continues to test how much MSNBC will tolerate
Media Matters has already documented Pat Buchanan's racially charged and often sexist campaign against Sotomayor. Despite his recent (and past) behavior, however, MSNBC has provided Buchanan with a prominent platform from which to spew his invective. This week, Foser asked a question MSNBC -- which in the past has had to fire Michael Savage and Don Imus for their remarks -- should answer: just what would Pat Buchanan have to say to be fired from the network?
Well, during this past week, Buchanan was curiously absent from much of MSNBC's commentary. Was it a sign that the network might be re-evaluating its relationship with one of its favorite "analysts"? If so, it should take note of the fact that Buchanan is set to host what the Southern Poverty Law Center called a "prominent white nationalist" at the upcoming conference of The American Cause, a Buchanan-led organization.
A growing history of violence (and denial)
6-12/09
This week, the country's attention was captured by the horrific shooting at the U.S. Holocaust Memorial Museum, allegedly by James W. von Brunn, an 88-year-old man with ties to white supremacist and anti-Semitic organizations. The fatal shooting came just two months after an April 7 Department of Homeland Security report detailing potential increases in right-wing extremism.
As Media Matters for America documented, the DHS report was immediately and vehemently rejected by numerous conservative commentators, such as Lou Dobbs, Rush Limbaugh, Sean Hannity, Michelle Malkin, and David Asman, who portrayed it as an illegitimate and politically motivated assault on conservatives. (Media Matters Senior Fellow Karl Frisch puts the attacks in even broader perspective here.)
Following the Holocaust Memorial Museum attack, these commentators faced criticism for their earlier dismissiveness. Some have since unconvincingly (and in the case of Joe Scarborough, inaccurately) defended their past assessment, and a handful of reporters and analysts are still engaging in falsehoods and inconsistencies in criticizing the DHS report. But on Fox News, Shepard Smith took a different position -- for which he was attacked by conservatives -- saying that the report "was a warning to us all. And it appears now that they were right."
The day before the Holocaust Memorial Museum attack, Media Matters Senior Fellow Eric Boehlert wrote that Fox News and its hosts "will have more right-wing vigilantism to explain." He added that "militia-style vigilante rhetoric has become a cornerstone of the conservative media movement in America, and it's now proudly championed by Fox News on a nearly hourly basis." (He also appeared on CNN this week.)
While right-wing media are certainly not legally culpable for any recent attacks, they are responsible for promoting a culture of fear, paranoia, and violence that is anti-government in the extreme -- a culture in which extremists, including von Brunn and Richard Poplawski, who fatally shot three Pittsburgh police officers, were apparently immersed. Poplawski was convinced that the Obama administration was going to take away his guns. Even though no evidence of such a policy exists, right-wing commentators and news organizations made the claim repeatedly before the shooting and have continued to do so since.
Predictably, conservative media figures responded to the museum shooting by attempting to shift attention away from themselves and onto political liberals and even President Obama himself. On June 10, the day of the museum shooting, financial analyst and radio host Jim Lacamp said on Fox News that "we have an administration that's really done a lot of class warfare, a lot of class-baiting. And so, it sets the stage for social unrest." That same day, conservative Tammy Bruce wrote that the Obama administration's "increasing anti-Israel rhetoric and the pandering to the Jew-hating world Arab world ... encourages all the beasts among us." Newsmax.com published an op-ed, cited on Friday by Michael Savage, claiming that Obama "is most certainly creating a climate of hate against" Jews. Colorado radio host Bob Newman even raised questions about whether Obama's recent visit to a concentration camp, or his statement about Israeli settlements, were factors in the shooting.
But as always, the most virulent reality-denier was Rush Limbaugh. Limbaugh claimed that von Brunn "is a leftist if anything." He said that Obama is "ramping up hatred for Israel" and that "anti-Jew rhetoric comes from the American left." He claimed that MSNBC broadcasts "hate 24/7." Despite the right wing's repeated use of violent, revolutionary rhetoric, Limbaugh said that it was actually Obama who "thrives and needs chaos" to succeed. And in response to Shepard Smith, he remarked that the "claim that the atmosphere is somehow more violently anti-Obama is simply preposterous."
Indeed, Smith's remarks were the exception for the right. Despite its love of fearmongering, Fox News spent the 24 hours after the von Brunn shooting downplaying it. And on his broadcast that night, Bill O'Reilly, who hypocritically and incorrectly criticized the media for a supposed lack of coverage after the shooting death of Army recruiter Pvt. William Long, and who stokes the anger of viewers whenever it suits him politically, barely mentioned the shooting and instead featured what he called a "very important story" on gay penguins. "Do they wear tight T-shirts?" he asked, laughing. During the two shows after the shooting, Hannity barely mentioned it.
Other major stories this week:
Newt in the news
This was a big week for former House Speaker Newt Gingrich, who is clearly attempting to position himself as the new (aka, old) voice of the GOP. (And according to USA Today, he's in the running.)
Newt, who had previously backed off of referring to Judge Sonia Sotomayor as a "racist," began the week by modifying his argument and repeating the dubious claim that she "clearly supported racial quotas" in the Frank Ricci case.
He followed it up at a congressional Republican fundraiser by proudly declaring that he was "not a citizen of the world," saying that "the entire concept is intellectual nonsense and stunningly dangerous." CNN's Candy Crowley and CQ Politics' Jonathan Allen reported Gingrich's statement without noting that President Ronald Reagan made similar remarks while addressing the United Nations in 1982. (You would think that Gingrich, a former history teacher, would have known better.) After Media Matters documented the oversight, MSNBC's David Shuster and Keith Olbermann, as well as by NBC's Brian Williams, subjected Gingrich's remarks to scrutiny.
Newt closed the week by reacting to a Weekly Standard article discussing the ongoing U.S. practice of reading Miranda rights to detainees. On Fox News' Hannity, Gingrich said that it was "unimaginable. It's worse than anything Jimmy Carter ever did. It's worse than anything that President Bill Clinton ever did." In doing so, he ignored the part of the article reporting that the FBI also Mirandized people at "specific bases" during the Bush administration.
Newt's factually challenged analysis has come to be so legendary that even MSNBC's Mike Barnicle felt compelled to ask, "[W]hy would anyone pay attention to anything he says?" It's a good question. Perhaps it's because networks like Fox News do whatever they can to make Gingrich, who hasn't held any office or official position since 1998, relevant.
Health care reform is coming, and the news is already making me sick
All three national networks covered a Thursday town hall meeting that Obama held in Wisconsin, during which he laid out his health care proposals in detail. And yet, not one of them reported on the substance of his remarks, focusing instead on a note he wrote for a 10-year-old girl who was skipping school.
On Friday, NPR's Mara Liasson claimed that the American Medical Association opposes a public plan as a component of health care reform, even though the AMA had backtracked the same day, stating that it was "willing to consider other variations of a public plan that are currently under discussion in Congress." Flaws in a New York Times story the day before about the AMA's position were the subject of Media Matters Senior Fellow Jamison Foser's column this week.
And during a Wednesday interview with Pennsylvania Sen. Bob Casey, MSNBC's Norah O'Donnell freely editorialized, lecturing him on how current proposals seemingly would "drive the deficit into these stratospheric numbers" and complaining that senators were engaging in "gobbledygook" on the issue.
The need for accurate and impartial reporting on impending legislation is made all the more acute by the long history and prevalence of misinformation from media conservatives on the issue. On Thursday, Limbaugh began pulling out the stops, sounding not unlike O'Donnell in the process. "And it's all about control," he said. "It's not about cost. This man's not worried about the cost of anything. He doesn't care what anything costs: a trip to New York for a date -- $12 trillion in debt over 10 years? He doesn't care what things cost." He went on to hypothesize that "exercise freaks ... are the ones putting stress on the health care system" because they keep getting injured.
Buchanan continues to test how much MSNBC will tolerate
Media Matters has already documented Pat Buchanan's racially charged and often sexist campaign against Sotomayor. Despite his recent (and past) behavior, however, MSNBC has provided Buchanan with a prominent platform from which to spew his invective. This week, Foser asked a question MSNBC -- which in the past has had to fire Michael Savage and Don Imus for their remarks -- should answer: just what would Pat Buchanan have to say to be fired from the network?
Well, during this past week, Buchanan was curiously absent from much of MSNBC's commentary. Was it a sign that the network might be re-evaluating its relationship with one of its favorite "analysts"? If so, it should take note of the fact that Buchanan is set to host what the Southern Poverty Law Center called a "prominent white nationalist" at the upcoming conference of The American Cause, a Buchanan-led organization.
Mainstream Medicine and the Oprah Factor
By DEEPAK CHOPRA posted on The Huffington Post
A recent cover story in a struggling news magazine, under the title "Crazy Talk:" accuses Oprah Winfrey of spreading "dubious advice" in a wide range of health issues from menopause and hormone replacement therapy to autism, cancer, aging, and weight loss. The tone of the article was the same tiresome blend of gotcha journalism and selective fact-reporting that fills tabloid coffers.
The story failed to gain traction for obvious reasons. Oprah has aired innumerable shows on health, of which the controversial ones are a tiny minority. Her intention to improve women's lives on all fronts is so obvious as to be almost above criticism. The credibility for women's well-being and welfare she has earned day after day over the past two decades will not be undone with a story that cherry-picks the guests who can be made easy targets of ridicule by the medical establishment. And the fact that she has celebrity guests who have causes and crusades in the area of health, such as Jenny McCarthy or Suzanne Somers, is not the same as Oprah herself endorsing what they say.
The criticism the medical establishment is directing at Oprah through this article only exposes their own frustration in having squandered their credibility with the public. They hope that if they can successfully attack the Oprah's immense credibility, then they can magically get some of that credibility back for themselves. However, if people still trusted the health care industry to act in their best interest the way they did decades ago, then it would be unnecessary to brand Oprah for "crazy talk" simply because she occasionally provides a forum for ideas outside of mainstream medicine.
The medical profession is burdened with a host of problems that Oprah addresses with more candor and force than the AMA. She promotes wellness and prevention, two areas that drastically need improvement. She brings up creative solutions to problems that medical science is baffled by, such as the healing response itself and the role of subjectivity in patient response. These are issues that few M.D.s are willing to explore, yet she has done so for decades.
Instead, we got a response from an oncologist in Canada repeating the establishment position: alternative treatments of cancer are bogus, subjectivity has no place in science, "soul talk" about illness is rubbish. This is exactly the kind of dismissive arrogance that drives millions of people away from conventional doctors. Every illness has a subjective component -- after all, to be sick is to change your moods and emotions, and severe illness causes one to examine primal issues like life and death and the meaning of existence. Do these subjective changes affect healing? Obviously they do, or we wouldn't have the placebo effect, which comes into play at least 30% of the time in illness.
Scientific medicine by and large ignores wellness, prevention, and alternative medicine in general. On a daily basis doctors don't deal in these things; few take courses in medical school centered on them. That's why a massive movement has arisen driven by patients themselves. Oprah serves as a public outlet for a conversation that needs to be ongoing. As long as official medicine, backed by huge pharmaceutical companies, denies the existence of the problem, much less alternative solutions, the movement will remain patient-centered and the attitude toward alternative medicine will be one of unfounded disdain, suspicion, and ignorance on the part of physicians.
Denial also plays a huge part in this story. Mainstream medicine continues to downplay the enormous drawbacks of a health-care system that is addicted to drugs and surgery as the two constant drumbeats of treatment. This lopsided emphasis has created dilemmas that official medicine hasn't remotely solved:
* In Seattle a recent study of 638 patients with chronic lower back pain were given either some sort of acupuncture or standard treatment with anti-inflammatory drugs and massage. On average, the acupuncture patients received twice as much benefit as those on standard treatment. The kicker is that some of the patients received fake acupuncture -- they were pricked superficially with toothpicks -- and received the same relief.
* Iatrogenic disease, roughly defined as illness that results as a complication from a doctor's care, leads to between 230,000 to 284,000 deaths every year, making it the third leading cause of fatality in the country.
* A survey of 1,249 health care professionals found that 81% had taken dietary supplements like vitamins and minerals. This, despite the fact that mainstream doctors frequently tell their patients that the only benefit of such supplements is "expensive urine."
* Two of the most frequently performed surgeries, heart bypass grafts and balloon angioplasty, became fashionable without serious testing (the government approves drugs but not surgical procedures). They continue to be used in the face of perennial findings that neither procedure increases life expectancy. Besides relieving symptoms, which of course can be very troubling to the patient, both procedures carry serious risks. (The most recent finding showed that diabetics with stable heart disease do not survive longer if given heart surgery.)
* In the past, such common procedures as hysterectomies and radical mastectomies were widely performed without testing their efficacy. Not until European results revealed that lumpectomies were often just as effective did American surgeons question the staunch support of mastectomies. One might also consider that surgeons were very slow to perform cosmetic breast replacement for women who faced devastating psychological fallout from their mastectomies -- a typical neglect of any patient's subjective response to illness.
* The benefit of lifestyle changes has been grossly underestimated and underused. Coronary heart disease, prostate cancer/breast cancer, diabetes, and obesity account for 75% of health care costs, yet the progression of these diseases may often be stopped or even reversed by making intensive lifestyle changes. The most recent findings show that such changes actually cause beneficial alterations at the genetic level, affecting up to 400 genes through such measures as improved diet, exercise, and meditation.
* Overall, this country's health care system is actually a "sick care" system. In 2006, $2.1 trillion were spent in the U.S. on medical care, 95% of which was spent to treat disease after it had already occurred.
We're just scratching the surface here. Yet even if these massive problems didn't exist, the Oprah affair raises the question of sins by omission. It's one thing for official medicine to decry alternative medicine and hurl accusations of quackery, not just at the non-M.D.s who work as health practitioners but at licensed, highly educated and qualified physicians who are creative enough to explore new avenues of treatment. Their own lack of curiosity and creative thinking is disturbing. Does the most brilliant researcher in the world know why cancer sometimes spontaneously disappears? Why a patient with obsessive-compulsive disorder or depression can respond equally well to talk therapy and drugs -- that is, why talk is as effective as chemicals in altering the brain? Or how the body's healing system is influenced by outside forces?
The answer is no. Which means that mysteries remain to be solved, and creative solutions have every chance of arising from unexpected quarters. Scientific medicine is leery of so-called anecdotal evidence, that is, individual stories of disease and cure. Their skepticism is rational and well-founded. We all agree that without impartial studies, the advance of knowledge becomes chaotic and untrustworthy. But Oprah is letting individuals tell their stories for other, positive reasons: to share their pain, to reach out to others in the same circumstance, to provide hope.
Official medicine falls short on these fronts far too often. It would be laughable if it weren't so sad that the typical TV ad for drugs paints glossy pictures of happy patients running through flowery meadows, ending with a list of every imaginable side effect, including death. The article sneers at the popular movement linking autism with childhood vaccination, yet current understanding looks at autism as a complex, multi-factorial condition in which some cases could be influenced by an outside factor like a vaccine. It's all too easy for medicine to disdain that possibility and cry foul against guests on Oprah's show, raising a smokescreen for the countless irresponsible prescriptions written, especially for elderly patients, by doctors every day.
One fears that all of these arguments will fall on deaf ears, because the schism between official and alternative medicine runs deep -- deep enough that the average physician doesn't bother even to skim the thousands of studies that bolster alternative claims. So let me offer a typical finding that comes from the Centers for Disease Control and Prevention, among other official sources. It concerns the effect of child abuse and other adverse circumstances on later health. Is it "soul talk" to believe that a child raised around parents who abuse substances, who suffer from mental illness, or who outright abuse the child will suffer health risks later in life?
According to the CDC study, covering 15,000 HMO members in San Diego between 1995-97, the risk of contracting an autoimmune disease as an adult is increased from 70% to 100% if you happened to be abused as a child or grow up with adverse home conditions. This finding isn't isolated. Autoimmune diseases are one in which the body's immune system attacks the body itself. There are few known causes; it is baffling to grasp why the body's chief defender against illness should turn around and become the cause of illness. This study suggests a human connection rather than a biological one. Or rather, human distress leads to biological distress. Doctors don't officially believe that; millions of ordinary citizens do. Earlier studies had already correlated adverse childhood conditions with the risk of inflammatory conditions. In the little picture, a new finding has been added to the long list of mind-body links for illness and aging. In the bigger picture, the fact that we don't fully understand the mind-body connection, much less use it for healing in official medicine, comes into glaring relief.
What this tells me is that medicine needs Oprah and other patient advocates who are demanding that official medicine heal itself. To accuse them of lacking medial credibility is a red herring. Patients aren't supposed to know more than their physicians. The fact that they often do, at least insofar as alternative treatment goes, is both a sign of hope and cause for distress.
A recent cover story in a struggling news magazine, under the title "Crazy Talk:" accuses Oprah Winfrey of spreading "dubious advice" in a wide range of health issues from menopause and hormone replacement therapy to autism, cancer, aging, and weight loss. The tone of the article was the same tiresome blend of gotcha journalism and selective fact-reporting that fills tabloid coffers.
The story failed to gain traction for obvious reasons. Oprah has aired innumerable shows on health, of which the controversial ones are a tiny minority. Her intention to improve women's lives on all fronts is so obvious as to be almost above criticism. The credibility for women's well-being and welfare she has earned day after day over the past two decades will not be undone with a story that cherry-picks the guests who can be made easy targets of ridicule by the medical establishment. And the fact that she has celebrity guests who have causes and crusades in the area of health, such as Jenny McCarthy or Suzanne Somers, is not the same as Oprah herself endorsing what they say.
The criticism the medical establishment is directing at Oprah through this article only exposes their own frustration in having squandered their credibility with the public. They hope that if they can successfully attack the Oprah's immense credibility, then they can magically get some of that credibility back for themselves. However, if people still trusted the health care industry to act in their best interest the way they did decades ago, then it would be unnecessary to brand Oprah for "crazy talk" simply because she occasionally provides a forum for ideas outside of mainstream medicine.
The medical profession is burdened with a host of problems that Oprah addresses with more candor and force than the AMA. She promotes wellness and prevention, two areas that drastically need improvement. She brings up creative solutions to problems that medical science is baffled by, such as the healing response itself and the role of subjectivity in patient response. These are issues that few M.D.s are willing to explore, yet she has done so for decades.
Instead, we got a response from an oncologist in Canada repeating the establishment position: alternative treatments of cancer are bogus, subjectivity has no place in science, "soul talk" about illness is rubbish. This is exactly the kind of dismissive arrogance that drives millions of people away from conventional doctors. Every illness has a subjective component -- after all, to be sick is to change your moods and emotions, and severe illness causes one to examine primal issues like life and death and the meaning of existence. Do these subjective changes affect healing? Obviously they do, or we wouldn't have the placebo effect, which comes into play at least 30% of the time in illness.
Scientific medicine by and large ignores wellness, prevention, and alternative medicine in general. On a daily basis doctors don't deal in these things; few take courses in medical school centered on them. That's why a massive movement has arisen driven by patients themselves. Oprah serves as a public outlet for a conversation that needs to be ongoing. As long as official medicine, backed by huge pharmaceutical companies, denies the existence of the problem, much less alternative solutions, the movement will remain patient-centered and the attitude toward alternative medicine will be one of unfounded disdain, suspicion, and ignorance on the part of physicians.
Denial also plays a huge part in this story. Mainstream medicine continues to downplay the enormous drawbacks of a health-care system that is addicted to drugs and surgery as the two constant drumbeats of treatment. This lopsided emphasis has created dilemmas that official medicine hasn't remotely solved:
* In Seattle a recent study of 638 patients with chronic lower back pain were given either some sort of acupuncture or standard treatment with anti-inflammatory drugs and massage. On average, the acupuncture patients received twice as much benefit as those on standard treatment. The kicker is that some of the patients received fake acupuncture -- they were pricked superficially with toothpicks -- and received the same relief.
* Iatrogenic disease, roughly defined as illness that results as a complication from a doctor's care, leads to between 230,000 to 284,000 deaths every year, making it the third leading cause of fatality in the country.
* A survey of 1,249 health care professionals found that 81% had taken dietary supplements like vitamins and minerals. This, despite the fact that mainstream doctors frequently tell their patients that the only benefit of such supplements is "expensive urine."
* Two of the most frequently performed surgeries, heart bypass grafts and balloon angioplasty, became fashionable without serious testing (the government approves drugs but not surgical procedures). They continue to be used in the face of perennial findings that neither procedure increases life expectancy. Besides relieving symptoms, which of course can be very troubling to the patient, both procedures carry serious risks. (The most recent finding showed that diabetics with stable heart disease do not survive longer if given heart surgery.)
* In the past, such common procedures as hysterectomies and radical mastectomies were widely performed without testing their efficacy. Not until European results revealed that lumpectomies were often just as effective did American surgeons question the staunch support of mastectomies. One might also consider that surgeons were very slow to perform cosmetic breast replacement for women who faced devastating psychological fallout from their mastectomies -- a typical neglect of any patient's subjective response to illness.
* The benefit of lifestyle changes has been grossly underestimated and underused. Coronary heart disease, prostate cancer/breast cancer, diabetes, and obesity account for 75% of health care costs, yet the progression of these diseases may often be stopped or even reversed by making intensive lifestyle changes. The most recent findings show that such changes actually cause beneficial alterations at the genetic level, affecting up to 400 genes through such measures as improved diet, exercise, and meditation.
* Overall, this country's health care system is actually a "sick care" system. In 2006, $2.1 trillion were spent in the U.S. on medical care, 95% of which was spent to treat disease after it had already occurred.
We're just scratching the surface here. Yet even if these massive problems didn't exist, the Oprah affair raises the question of sins by omission. It's one thing for official medicine to decry alternative medicine and hurl accusations of quackery, not just at the non-M.D.s who work as health practitioners but at licensed, highly educated and qualified physicians who are creative enough to explore new avenues of treatment. Their own lack of curiosity and creative thinking is disturbing. Does the most brilliant researcher in the world know why cancer sometimes spontaneously disappears? Why a patient with obsessive-compulsive disorder or depression can respond equally well to talk therapy and drugs -- that is, why talk is as effective as chemicals in altering the brain? Or how the body's healing system is influenced by outside forces?
The answer is no. Which means that mysteries remain to be solved, and creative solutions have every chance of arising from unexpected quarters. Scientific medicine is leery of so-called anecdotal evidence, that is, individual stories of disease and cure. Their skepticism is rational and well-founded. We all agree that without impartial studies, the advance of knowledge becomes chaotic and untrustworthy. But Oprah is letting individuals tell their stories for other, positive reasons: to share their pain, to reach out to others in the same circumstance, to provide hope.
Official medicine falls short on these fronts far too often. It would be laughable if it weren't so sad that the typical TV ad for drugs paints glossy pictures of happy patients running through flowery meadows, ending with a list of every imaginable side effect, including death. The article sneers at the popular movement linking autism with childhood vaccination, yet current understanding looks at autism as a complex, multi-factorial condition in which some cases could be influenced by an outside factor like a vaccine. It's all too easy for medicine to disdain that possibility and cry foul against guests on Oprah's show, raising a smokescreen for the countless irresponsible prescriptions written, especially for elderly patients, by doctors every day.
One fears that all of these arguments will fall on deaf ears, because the schism between official and alternative medicine runs deep -- deep enough that the average physician doesn't bother even to skim the thousands of studies that bolster alternative claims. So let me offer a typical finding that comes from the Centers for Disease Control and Prevention, among other official sources. It concerns the effect of child abuse and other adverse circumstances on later health. Is it "soul talk" to believe that a child raised around parents who abuse substances, who suffer from mental illness, or who outright abuse the child will suffer health risks later in life?
According to the CDC study, covering 15,000 HMO members in San Diego between 1995-97, the risk of contracting an autoimmune disease as an adult is increased from 70% to 100% if you happened to be abused as a child or grow up with adverse home conditions. This finding isn't isolated. Autoimmune diseases are one in which the body's immune system attacks the body itself. There are few known causes; it is baffling to grasp why the body's chief defender against illness should turn around and become the cause of illness. This study suggests a human connection rather than a biological one. Or rather, human distress leads to biological distress. Doctors don't officially believe that; millions of ordinary citizens do. Earlier studies had already correlated adverse childhood conditions with the risk of inflammatory conditions. In the little picture, a new finding has been added to the long list of mind-body links for illness and aging. In the bigger picture, the fact that we don't fully understand the mind-body connection, much less use it for healing in official medicine, comes into glaring relief.
What this tells me is that medicine needs Oprah and other patient advocates who are demanding that official medicine heal itself. To accuse them of lacking medial credibility is a red herring. Patients aren't supposed to know more than their physicians. The fact that they often do, at least insofar as alternative treatment goes, is both a sign of hope and cause for distress.
Friday, June 12, 2009
The Big Hate
NY TIMES By PAUL KRUGMAN
Back in April, there was a huge fuss over an internal report by the Department of Homeland Security warning that current conditions resemble those in the early 1990s — a time marked by an upsurge of right-wing extremism that culminated in the Oklahoma City bombing.
Conservatives were outraged. The chairman of the Republican National Committee denounced the report as an attempt to “segment out conservatives in this country who have a different philosophy or view from this administration” and label them as terrorists.
But with the murder of Dr. George Tiller by an anti-abortion fanatic, closely followed by a shooting by a white supremacist at the United States Holocaust Memorial Museum, the analysis looks prescient.
There is, however, one important thing that the D.H.S. report didn’t say: Today, as in the early years of the Clinton administration but to an even greater extent, right-wing extremism is being systematically fed by the conservative media and political establishment.
Now, for the most part, the likes of Fox News and the R.N.C. haven’t directly incited violence, despite Bill O’Reilly’s declarations that “some” called Dr. Tiller “Tiller the Baby Killer,” that he had “blood on his hands,” and that he was a “guy operating a death mill.” But they have gone out of their way to provide a platform for conspiracy theories and apocalyptic rhetoric, just as they did the last time a Democrat held the White House.
And at this point, whatever dividing line there was between mainstream conservatism and the black-helicopter crowd seems to have been virtually erased.
Exhibit A for the mainstreaming of right-wing extremism is Fox News’s new star, Glenn Beck. Here we have a network where, like it or not, millions of Americans get their news — and it gives daily airtime to a commentator who, among other things, warned viewers that the Federal Emergency Management Agency might be building concentration camps as part of the Obama administration’s “totalitarian” agenda (although he eventually conceded that nothing of the kind was happening).
But let’s not neglect the print news media. In the Bush years, The Washington Times became an important media player because it was widely regarded as the Bush administration’s house organ. Earlier this week, the newspaper saw fit to run an opinion piece declaring that President Obama “not only identifies with Muslims, but actually may still be one himself,” and that in any case he has “aligned himself” with the radical Muslim Brotherhood.
And then there’s Rush Limbaugh. His rants today aren’t very different from his rants in 1993. But he occupies a different position in the scheme of things. Remember, during the Bush years Mr. Limbaugh became very much a political insider. Indeed, according to a recent Gallup survey, 10 percent of Republicans now consider him the “main person who speaks for the Republican Party today,” putting him in a three-way tie with Dick Cheney and Newt Gingrich. So when Mr. Limbaugh peddles conspiracy theories — suggesting, for example, that fears over swine flu were being hyped “to get people to respond to government orders” — that’s a case of the conservative media establishment joining hands with the lunatic fringe.
It’s not surprising, then, that politicians are doing the same thing. The R.N.C. says that “the Democratic Party is dedicated to restructuring American society along socialist ideals.” And when Jon Voight, the actor, told the audience at a Republican fund-raiser this week that the president is a “false prophet” and that “we and we alone are the right frame of mind to free this nation from this Obama oppression,” Mitch McConnell, the Senate minority leader, thanked him, saying that he “really enjoyed” the remarks.
Credit where credit is due. Some figures in the conservative media have refused to go along with the big hate — people like Fox’s Shepard Smith and Catherine Herridge, who debunked the attacks on that Homeland Security report two months ago. But this doesn’t change the broad picture, which is that supposedly respectable news organizations and political figures are giving aid and comfort to dangerous extremism.
What will the consequences be? Nobody knows, of course, although the analysts at Homeland Security fretted that things may turn out even worse than in the 1990s — that thanks, in part, to the election of an African-American president, “the threat posed by lone wolves and small terrorist cells is more pronounced than in past years.”
And that’s a threat to take seriously. Yes, the worst terrorist attack in our history was perpetrated by a foreign conspiracy. But the second worst, the Oklahoma City bombing, was perpetrated by an all-American lunatic. Politicians and media organizations wind up such people at their, and our, peril.
Back in April, there was a huge fuss over an internal report by the Department of Homeland Security warning that current conditions resemble those in the early 1990s — a time marked by an upsurge of right-wing extremism that culminated in the Oklahoma City bombing.
Conservatives were outraged. The chairman of the Republican National Committee denounced the report as an attempt to “segment out conservatives in this country who have a different philosophy or view from this administration” and label them as terrorists.
But with the murder of Dr. George Tiller by an anti-abortion fanatic, closely followed by a shooting by a white supremacist at the United States Holocaust Memorial Museum, the analysis looks prescient.
There is, however, one important thing that the D.H.S. report didn’t say: Today, as in the early years of the Clinton administration but to an even greater extent, right-wing extremism is being systematically fed by the conservative media and political establishment.
Now, for the most part, the likes of Fox News and the R.N.C. haven’t directly incited violence, despite Bill O’Reilly’s declarations that “some” called Dr. Tiller “Tiller the Baby Killer,” that he had “blood on his hands,” and that he was a “guy operating a death mill.” But they have gone out of their way to provide a platform for conspiracy theories and apocalyptic rhetoric, just as they did the last time a Democrat held the White House.
And at this point, whatever dividing line there was between mainstream conservatism and the black-helicopter crowd seems to have been virtually erased.
Exhibit A for the mainstreaming of right-wing extremism is Fox News’s new star, Glenn Beck. Here we have a network where, like it or not, millions of Americans get their news — and it gives daily airtime to a commentator who, among other things, warned viewers that the Federal Emergency Management Agency might be building concentration camps as part of the Obama administration’s “totalitarian” agenda (although he eventually conceded that nothing of the kind was happening).
But let’s not neglect the print news media. In the Bush years, The Washington Times became an important media player because it was widely regarded as the Bush administration’s house organ. Earlier this week, the newspaper saw fit to run an opinion piece declaring that President Obama “not only identifies with Muslims, but actually may still be one himself,” and that in any case he has “aligned himself” with the radical Muslim Brotherhood.
And then there’s Rush Limbaugh. His rants today aren’t very different from his rants in 1993. But he occupies a different position in the scheme of things. Remember, during the Bush years Mr. Limbaugh became very much a political insider. Indeed, according to a recent Gallup survey, 10 percent of Republicans now consider him the “main person who speaks for the Republican Party today,” putting him in a three-way tie with Dick Cheney and Newt Gingrich. So when Mr. Limbaugh peddles conspiracy theories — suggesting, for example, that fears over swine flu were being hyped “to get people to respond to government orders” — that’s a case of the conservative media establishment joining hands with the lunatic fringe.
It’s not surprising, then, that politicians are doing the same thing. The R.N.C. says that “the Democratic Party is dedicated to restructuring American society along socialist ideals.” And when Jon Voight, the actor, told the audience at a Republican fund-raiser this week that the president is a “false prophet” and that “we and we alone are the right frame of mind to free this nation from this Obama oppression,” Mitch McConnell, the Senate minority leader, thanked him, saying that he “really enjoyed” the remarks.
Credit where credit is due. Some figures in the conservative media have refused to go along with the big hate — people like Fox’s Shepard Smith and Catherine Herridge, who debunked the attacks on that Homeland Security report two months ago. But this doesn’t change the broad picture, which is that supposedly respectable news organizations and political figures are giving aid and comfort to dangerous extremism.
What will the consequences be? Nobody knows, of course, although the analysts at Homeland Security fretted that things may turn out even worse than in the 1990s — that thanks, in part, to the election of an African-American president, “the threat posed by lone wolves and small terrorist cells is more pronounced than in past years.”
And that’s a threat to take seriously. Yes, the worst terrorist attack in our history was perpetrated by a foreign conspiracy. But the second worst, the Oklahoma City bombing, was perpetrated by an all-American lunatic. Politicians and media organizations wind up such people at their, and our, peril.
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