Monday, February 2, 2009

Universal Health Care? Dream On

Image credit: Official U.S. Senate photo from Wikimedia Commons

Back when there were more than two candidates in the Democratic Presidential primary, I looked over the health care plans of Hillary Clinton, John Edwards, and Barack Obama. While I never wrote much about them here at the time, my opinion was that of the three, Edwards' was the only one that truly had a chance of working out for us ordinary folks, particularly for those of us who are self-employed, part time workers, or otherwise uncovered by company medical plans. Clinton's looked like a great plan for the insurance industry, and Obama's didn't look like much of a plan at all.

It wasn't until I read Glenn Greenwald's Sunday column that I started to realize why Obama's plan was, to put it kindly, sketchy. What filled in the blanks was his choice for HHS Secretary:

[Tom Daschle] embodies everything that is sleazy, sickly, and soul-less about Washington. It's probably impossible for Obama to fill his cabinet with individuals entirely free of Beltway filth -- it's extremely rare to get anywhere near that system without being infected by it -- but Daschle oozes Beltway slime from every pore.

Before he was elected to Congress 30 years ago from South Dakota, he had very, very few skills outside of the political arena. He was an Air Force intelligence officer for three years in the early 1970s, then worked for six years as an aide to South Dakota Sen. James Abourezk, then was elected to the House and then the Senate, where he became Majority Leader. So he's spent virtually his entire adult life working on Capitol Hill.

Despite that (or rather: precisely because of it), after being defeated for re-election to the Senate in 2004, he was able almost immediately to begin earning millions of dollars every year from firms and companies that depend on exerting influence in Congress

The Daschles: Feeding At The Beltway Trough

At his Rolling Stone blog, Matt Taibbi sums up the pick of Daschle this way:

[I]n picking Daschle — who as an adviser to the K Street law firm Alston and Bird has spent the last four years burning up the sheets with the nation's fattest insurance and pharmaceutical interests — Obama is essentially announcing that he has no intention of seriously reforming the health care industry. And I know that lots of public policy people are hailing this pick, saying Daschle is perfect for the job ("His new leadership position confirms that the incoming Obama administration has made health care reform a top and early priority for action in 2009," Ron Pollack, the director of Families USA, told reporters), but when they say that I think they mean the following: "Out of all the bought-off Washington whores who could have been given this job, Daschle is the best one. His fake reform will go the farthest in its approximation of actual action than the fake reform of any other possible whore-candidate."

The Whore Factor

I'll leave you to read Taibbi's rather graphic protrayal of Daschle's character for yourselves. Suffice to say, he's not a fan. Just search for the word "cheeseburger", and just make sure you're not digesting anything.

Daschle's Sourcewatch page is remarkably free of any mention of his work at Washington lobbying firm Alston and Bird, but their page on the firm mentions that one of their primary client markets is the healthcare and pharmaceuticals sector. The Chicago Tribune reports:

Though not a registered lobbyist, the South Dakota Democrat over the past two years earned more than $2.1 million as a "special policy adviser" at Alston & Bird, a law firm with more than 50 lobbying clients in the health-care industry.

Tom Daschle Faces Questions On Taxes, Health-care Work Ahead Of Confirmation As Secretary of Health and Human Services

It's funny how most of the attention lately has been on Daschle's tax problems, when the problem we should be concerned about is how beholden he is to the very industries he's supposed to ride herd on as Secretary of HHS. The Los Angeles Times adds:

According to financial disclosure forms filed with the Office of Government Ethics, Daschle also took in $153,200 in 2008 for giving speeches to healthcare companies and industry groups such as GE Healthcare, a leading manufacturer of medical devices.

A decade ago, Daschle's wife did some work for the healthcare industry as well. In 1999 and 2000, Linda Daschle was among a group of lobbyists at Baker Donelson Bearman & Caldwell who represented the drug maker Schering-Plough Corp., which paid the law firm $470,000 over the two years, according to federal lobbying reports.

Tom Daschle To Face Close Scrutiny

You might find it ironic that Republican Senators plan to grill Daschle on this matter, but Daschle's own record shows how pervasive the revolving door culture can be in our nation's capital. All I can say about the irony is that I'm just glad there are still two major parties in DC. If there were any fewer, we probably wouldn't be hearing about this at all.

Even assuming Daschle was willing to say goodbye to all that, it's unlikely that he'll also be willing to work his wife out of a living.

Equally unimpressive is President Obama's choice for Surgeon General. Dr. Sanjay Gupta is, as many people are aware, a medical correspondent for CNN. Just that statement would be cause for suspicion about where his loyalties lie, given that so much commercial time is bought by insurance, pharmaceutical, and healthcare companies. As The New Republic observed:

For over six years, Gupta has been co-hosting “AccentHealth”—a CNN television segment beamed straight into doctors’ waiting rooms, sponsored in part by many of the major pharmaceutical companies. Touted on its website as an “integrated marketing opportunity” that allows companies to deliver their message “in a trusted environment,” the show has been underwritten by drug industry leaders Aventis, Pfizer, Procter & Gamble, Merck, and Warner Lambert.

Sanjay Gupta Treads the Ethical Line

But suspicion doesn't equal guilt, so let's look at what Dr. Gupta's been up to. That same TNR article goes on to say:

At the same time, Gupta has been appearing on CNN’s primary broadcasts as an ostensibly objective medical authority, discussing the drugs produced by the very same pharmaceutical companies. In a November 2003 broadcast of CNN’s “American Morning,” Gupta described the benefits of the cholesterol-reducing drug Lipitor, which is produced by Pfizer:

I actually talked to the doctor who did this study and I asked him the same question. I asked him about myself, I said, “Should I be on this medication?” And he sort of laughed, and said, “I'm not ready to do that over the phone,” as a good doctor would. But he said, for the most part, it's a pretty good drug and there's very few reasons not to be on it.

Later, in a 2005 “Accent Health” broadcast, Gupta took up his promotional mantle and advised viewers how to buy discounted Lipitor online. These weren’t the only times that Gupta’s news coverage involved medications manufactured by the companies that have sponsored the quasi-infomercial he co-hosts. Gupta has also name-dropped Allegra, a popular allergy medication manufactured by Aventis, as an allergy remedy on “AccentHealth” in 2005 and repeated on CNN’s “House Call With Dr. Sanjay Gupta” in 2006. And in 2006, he began reporting extensively on Gardasil, the HPV vaccine produced by Merck.

Sanjay Gupta Treads the Ethical Line

[links from original article]

Gupta got into a row recently with Michael Moore about the movie Sicko. Gupta claimed, with little basis in fact, that Moore "fudged" facts in the film. Sicko, of course, makes some rather embarrassing comparisons between foreign healthcare programs and our own. Media Matters noted, in fact, that Gupta had difficulty determining what conflicts of interest his expert guest on the subject might have, even though CNN's staff evidently did not:

After Sicko director Michael Moore said that CNN's Sicko fact-check "healthcare expert" Paul Keckley is "a person from a think tank group who is a big Republican contributor," CNN's Dr. Sanjay Gupta asserted that Keckley's "only affiliation" is with Vanderbilt University. Gupta continued, "We checked it, Michael. We checked his conflict of interest. We do ask those questions." In fact, as a caption accompanying Gupta's original report stated, Keckley is a "Deloitte Healthcare Expert."

In Sicko "fact check," CNN's Gupta falsely claimed his source's "only affiliation is with Vanderbilt University"

On the other hand, Gupta has done some interesting articles about the insurance situation for CNN. Reading them, one certainly gets the impression that he understands how much of a burden medical insurance costs are for both working people and their employers. What they don't show is a deep appreciation for the economics. Here is one quote from one of those articles:

I find it interesting the two states that put forward concrete universal health care plans, a core Democratic issue, were both led by Republican governors - Mitt Romney in Massachusetts and Schwarzenegger in California. I also wonder if the members of the Senate Health Committee in California looked at the successes and failures of the Massachusetts plans before voting their own plan down. While more people than ever are covered in Massachusetts, the cost overruns have been more than $400 million.

Learning from universal health care proposals

He finds that interesting? While it's really something of a bipartisan sport, helping insurance companies achieve greater profits is something Republicans have never been shy about in my experience. In the case of Massachusetts, the healthcare "reform" was to make it impossible to receive medical care unless you have insurance. There is some means testing, so the poor are at least helped out somewhat (anyone earning up to three times the poverty line). What created those cost overruns is that many more people needed assistance than were planned for. If anything, the Massachusetts plan has made it tougher for hospitals that care for the poor, which one would think would be an undesireable outcome. A recent report (PDF) indicates that per-capita health care costs are still rising in Massachusetts, despite claims that insuring everyone would decrease them. Such miscalculations aren't likely to be cured by Dr. Gupta's level of analysis.

Complicating any search for ties between Gupta and the industries he would be critiquing as Surgeon General is the fact that there's another Dr. Sanjay Gupta, who apparently is a psychiatrist (PDF). I suspect this means there'd be a certain overlap in the interests of these two doctors, since the Dr. Gupta I'm referring to is a neurosurgeon.

Why don't I find Gupta all that inspiring a choice for Surgeon General? After all, he's someone who's used to communicating with the public, which is an important part of the job. He's an accomplished doctor and academic, even though his specialty strikes some as a bit limited. However, besides his apparent bias toward keeping the broken parts of our medical system the way they are, there's a more basic difficulty - the possible alternatives. There are plenty of good choices who have at least as much relevant experience, and who aren't influenced by big pharma or the insurance companies. John Conyer's choice for the job is an example:

Alas, although CNN, and other national news organizations have covered Conyers' opposition to Gupta, they've failed to raise the public profile of Dr. Herbert Smitherman, the assistant dean at the WSU School of Medicine who is Conyers' on-record pick as the surgeon general.

Smitherman, a Cincinnati native who has spent his career in Detroit, says Conyers contacted him immediately after Obama's election, met with him, and said he would like to recommend him as surgeon general.

Smitherman does fit the Conyers profile of a surgeon general committed to helping those who don't have access to health care.

The co-author of "Taking Care of the Uninsured: A Path to Reform," Smitherman has degrees in engineering, medicine and public health and a medical practice providing care to the urban poor.

When he was named a 2003 Michiganian of the Year by The News, the headline read: "Sick, poor and think no one cares? Here's the man who does."

Top Doc Tussle Goes Local

[links added]

I don't know Dr. Smitherman, and I doubt I ever will, but he sounds like just the sort of person I'd want in that position. He's been part of a project to get inner city poor people in Detroit primary medical care, relieving emergency rooms of this task. He has academic credentials and an interesting academic background. He's had administrative experience, and he has first-hand knowledge of what it means to be poor in this country and need medical care. What's not to like?

Based on President Obama's top choices thus far, what's not to like is that he's not willing to make apologies for, or make a living from, the sorts of people who make the current healthcare system inaccessible to many of us. Who Obama chooses for these positions says a lot about how he wants to proceed in the area of health care. It strikes me as unlikely in the extreme that Daschle or Gupta would be convincing spokesmen for a single-payer system, or even for an expansion of Medicare or a similar program that would cover anyone who wants it.

This is not to say that Dr. Gupta couldn't be a good Surgeon General. He probably would, but if you're looking for someone to fix our health care mess, you need to look elsewhere. As the example of Dr. Smitherman suggests, "elsewhere" isn't necessarily so bad.

As things stand now, it seems clear that if we want universal health care that isn't just a protection racket for the insurance companies, or another price support for the pharmaceuticals, we need to demand it.

After all, as Obama would likely point out, Edwards lost, by a lot.

UPDATE (Feb. 3): Looks like we won't have Tom Daschle to kick around any more:

(CNN) -- The White House insists that it was entirely former Sen. Tom Daschle's decision to withdraw his nomination, but some observers say he didn't have a choice.

Despite the controversy over his tax records and his work in a field that some consider lobbying, Daschle was expected to be confirmed.

His withdrawal shocked Capitol Hill, and Democratic colleagues expressed regret over his decision.

Pressure on Daschle reaches tipping point

My guess, based on nothing but my innate cynicism, is that it was the tax stuff that prompted Daschle to "withdraw" his nomination. Note, though, that some of his Democratic colleagues see no problem with his trip through the revolving door.

If we don't make it plain what we want, the main difference will be that we just get a new SecHHS candidate who has a better accountant.


One Fly said...

This would have taken me a week and ten days to do and even then the the results would be questionable.

Nice job Cujo and you are right on with all of it.

Cujo359 said...

Thanks, One Fly. Actually, it took almost eight hours, counting going back and fixing stuff...

Dana Hunter said...

Worth every hour, too. Which is why I co-opted you as my official Thinking Brain dog.

Heh. Captcha: "petiout." Yup. I'd like to get the petty out - we don't need no stinkin' Sanjay Gupta when there's better SG's to be had.

selise said...

awesome post. thanks!

btw, came here from oxdown....

Mike at The Big Stick said...

Interesting post. One question though: I've always thought of the Surgeon General as really just a mouthpiece for government health policies.Here's what Wikipedia had to say:

The Surgeon General reports to the Assistant Secretary for Health (ASH), who is the principal advisor to the Secretary of Health and Human Services on public health and scientific issues. The Surgeon General is the overall head of the United States Public Health Service (PHS), a 6,000-member Commissioned Corps of the USPHS, a cadre of health professionals who are on call 24 hours a day, and can be dispatched by the Secretary of HHS or the Assistant Secretary for Health in the event of a public health emergency.

The Surgeon General is also the ultimate award authority for several public health awards and decorations, the highest of which that can be directly awarded is the Surgeon General's Medal (the highest award bestowed by board action is the Distinguished Service Medal). The Surgeon General also has many informal duties, such as educating the American public about health issues and advocating healthy lifestyle choices.

The office also periodically issues health warnings. Perhaps the best known example of this is the Surgeon General's Warning labels that can be found on all packages of American cigarettes. A health warning also appears on alcoholic beverages.

While it sounds like there are administrative functions, again, I still picture them wearing their uniform and just delivering messages that were actually crafted by their superiors. In that respect, wouldn't Gupta be a good choice? Your mention of Smitherman might be a better replacement for Daschle than Gupta since it sounds like he has practical experience in administrating programs.

One Fly said...

You done did scare him off Cujo!!

Cujo359 said...

Yes, Dana, I'd love to get the petty out of politics. Seems like it's human nature, though.

I'm just glad we got the Daschle out, as One Fly notes.

Cujo359 said...

Actually, Mike, I did write that Gupta would probably be a good choice for SG, it's just that he isn't a good choice if you want things fixed. I'm reasonably sure he would communicate with the public about public health issues, and would probably do a good job of it. He wouldn't be a convincing spokesman for the sort of change we need, though. What we need, at the risk of using a medical metaphor, is long, complicated, and invasive surgery on our health care system. Gupta's choice would probably be to give us some aspirin and apply a bandaid.

As for Dr. Smitherman, he might do OK as SecHHS, but he really hasn't had the kind of political experience that job would call for. President Obama has some great political instincts, though, and I think if he were willing to put Dr. Smitherman up for nomination, Smitherman would be good for the job.