Hightower Lowdown

Harry Truman said, "No man should be allowed to be president who doesn't understand hogs." That's never been more true than it will be for the man or woman who walks into the White House on January 20, 2009.

If you've ever entered an enclosed, industrialized hog facility where hundreds of fattening porcines live out their short lives, you know that the smell of pig excrement completely redefines "stink." This stench will knock you to your knees, sear your lungs and brain, and make you scream for mercy. For nearly eight years, the White House has been a confined hog pen for corporate porkers, right-wing ideologues, imperialists, autocrats, and other swinish mess-makers. America's next president must not only set a new direction but will also have to clean up the mess and eradicate the stink left by the Bushites.

To help presidential contenders, congressional candidates and the rest of us get perspective on the odiferous legacy of the Bush-Cheney regime, the Lowdown is presenting a two-part factual accounting of the administration's achievements since 2001. This issue will feature Bush's domestic performance, and the May issue will highlight his international agenda. Hold your nose--and get out your scrubbers. [ read more ]

How messed up is America's health-care system? Consider the case of the Leavitts. Anne and her husband Dixie, both in their 70s, got frazzled trying to work their way through the maddening maze of George W's new prescription-drug program, which compels seniors to choose among 1,400 competing drug-insurance schemes offered by 80 corporations. Each plan in this baffling "marketplace" offers different coverage, is frustratingly complex, and is filled with fine print. The Leavitts had to call on their son to help them select a company to cover their meds.

But -- oops! -- even with hands-on help, Anne and Dixie made a bad choice that almost cost them their entire medical coverage. They rushed to drop that plan and were lucky to find another at the last minute to avert a family disaster. What makes the Leavitt's story unique among the millions of seniors who've been similarly discombobulated by Bush's convoluted prescription plan (including 15 million who've been left with no drug coverage) is that their helpful son is none other than Mike Leavitt. Yes, the head honcho of Bush's Health and Human Services Department! One more twist: Dixie Leavitt made his fortune in the insurance business.

If someone who's an insurance professional and is personally advised by the government's top health official still gets flummoxed -- that's a clue that the Powers That Be have saddled us with a truly lousy program.

The health-industrial complex

There's no legitimate excuse for this mess. A program to provide medicines for every single senior could and should be simpler and far less expensive than Bush's $1/2 trillion scam. Medicare, with its extremely low overhead and an efficient payment system already in place, is the logical conduit for such a program. It could negotiate with drug makers on behalf of every senior to get low prices on all medicines, then pay pharmacists directly for the total cost of prescriptions they fill.

Instead, Bush and Congress put the new drug benefit in the hands of the corporate bureaucracies that separate us patients from our medical professionals. All seniors are on their own to purchase one of the confusing myriad of drug cards from HMOs and insurance companies. These middlemen then bill Medicare for whatever medications the seniors get and put no lid on the prices of the drugs.

Thus, rather than being a straightforward benefit for people in need, Bush's program has become a boondoggle benefit for America's bureaucratic, wasteful, fraud-ridden health-industrial complex. Such giants as UnitedHealth, Humana, and WellPoint (which have already scarfed up more than half of the new drug program's market) are given both a new source of monthly premiums and a generous federal subsidy to provide prescription coverage.

Not to be left out of the financial fun, the drug barons have obtained a green light to bloat their profits (already the highest of any industry) with overpriced pills that ultimately are paid for by Medicare dollars taken out of all of our paychecks. WARNING: The following fact could make your eyeballs explode: Bush demanded and got a provision in his new program that specifically prohibits Medicare officials from negotiating with drug corporations to lower the prices they charge. If only this were a bad horror movie! Alas, it's the core reality of America's sick health-care system. Wait, you say. We've got the top technology and medical know-how in the whole freakin' world. America is Number One! We have the healthiest people and we get the best quality health care there is, bar none. USA! USA! USA!

Well, that's the rah-rah myth we're fed by the industry, the media, and most politicians, but it's not true. Still, if you insist that the USA simply must be Number One, it is true that ours is by far the most expensive health-care system on the globe. Go USA! In 2004, spending averaged $6,280 for each man, woman, and child in America -- more than double the average ($2,307 per capita) spent in all other industrial countries.

Over 16% of our economy ($1.9 trillion last year) goes into our corporatized system -- 50% more than Switzerland's universal system, which ranks second in spending per person. Not only does the U.S. drastically outspend everyone else, but it does so while leaving tens of millions of Americans outside the system. In contrast, Canada puts only 10% of its economy into healthcare, Australia 9%, and England 7%, and these countries manage to provide care for every one of their people. [ read more ]

David Lubar is the author of a funny Q&A piece about HMOs that has made the rounds on the Internet. It begins: "Q. What Does HMO stand for? A. It is really an abbreviation of 'Hey, Moe!,' and it comes from Dr. Moe Howard, who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes."

Today's health care system does seem like a Three Stooges schtick, and it has certainly delivered a poke in the eye to both us patients and our doctors, benefitting no one but the handful of corporate executives whom we suddenly find in charge of health care for a nation of 270 million people (well, 225 million if you subtract the 45 million of us have no health coverage at all). Barely a decade ago, the insurance giants and their puppets in Washington were direly warning us about the grotesque evils of "Socialized Medicine"—bureaucrats would make medical decisions rather than doctors, they would not let us choose our own doctors, patients would be denied treatments they needed, health care money would be siphoned off to feed the bureaucracy, and the costs of the whole system would go through the roof.

Hello? Ten years later, this is the reality of health care in America. While the insurance companies had us watching in fear for any sign of socialized medicine, they snuck around behind us and created Corporatized Medicine.

In the last few years, what is now referred to as the health care industry has fallen into fewer and fewer hands. Met Life, Prudential, New York Life, Travelers, and John Hancock are among the major HMO competitors that were there a moment ago, but are now gone, gulped down whole, like a boa constrictor eats a pig, by the likes of Aetna, Cigna and UnitedHealth Group. Not only are these three already the dominant national players, but they divide up the country, city by city, which gives them near-monopoly power because most people don't leave town to go to the doctor.

Aetna, which is notorious for squeezing the care out of health care, has captured 40% of the Philadelphia market, nearly 60% in several New Jersey cities, and a third in Atlanta, Orlando, and San Antonio. As Consumers for Quality Care points out, "With greater market share in key cities and states, Aetna [has] put itself in a higher position to offer more patients less coverage for ever higher premiums." Two-thirds of the entire market is now in the hands of the 10 biggest companies.

Already, the consolidated HMO industry is acting not in competition, but in concert — in 1998, the biggest national firms decided virtually on the same day to dump their Medicare service for rural seniors, and in 1999 every one of them uniformly hiked premiums for all of their patients.
Spending on everything but healing

Not only are premiums up dramatically, and going higher again this year, but more and more of the money we spend is going, not to our health needs, but to corporate bureaucracies and CEO paychecks. The growth in the number of beancounters has far outstripped growth in nurses and doctors—there are now four times more clerks and managers than there are doctors. ... [ read more ]