This is a great article from Ezra Klein. First he makes clear that our current insurance system actually works against the commonhealth, not for it. Then he offers five steps to improving the system — none of which have any chance of ever happening — ultimately making the case for non-insurance-based, universal coverage:

It is actually counterproductive for insurers to compete on giving us the best care. It’s not simply that they’re not doing it, but given the structure of the marketplace, they shouldn’tdo it. Imagine insurer X creates the best damn diabetes protocols in the country. And they begin advertising this fact. What happens on Day Two? Well, they’re flooded with individuals suffering from diabetes, or individuals who fear they will one day be suffering from diabetes. These people, in the current system, are a bad deal. Not only is it near impossible to insure them at a profit, but pooling their costs (which is what insurers do, after all) raises premiums for all the insurer’s other customers. When the average customer of an insurer gets sicker, prices go up for all their customers. So the healthy folks contracting with that insurer quit the pool, and go find a cheaper deal, which forces the insurer to raise premiums again, driving out more healthy folks, which forces them to raise premiums again, which drives out more healthy folks, and so on. It’s what we call an insurance death spiral, and it ends with the collapse of the insurer.

Given those incentives, insurers cannot compete to offer better care, because if they offered better care, all that would happen is they would attract worse deals. Which is why, in the current system, insurers make things worse.

I finally got to watch Michael Moore’s Sicko two nights ago, a nice piece of timing as, the very next day Hillary Clinton announced her healthcare reform plan.

What a frikkin disappointment she and the rest of the Democratic hopefuls (with the exception of Kucinich) have turned out to be. She is pushing her version of the same approach that Republican governors have pushed on Massachusetts and California: mandantory bondage to the insurance companies.

As with the Iraq War, it just doesn’t matter that strong majorities of the American people favor a single-payer, government-run system, like they enjoy in Canada, England, France, etc.

In fact, Clinton emphatically stated that her plan was anything but that. She willingly joins in the “socialized medicine=evil” frame that has brought us our current mess of a system. Government can be trusted to fight wars and put out fires and  deliver mail and, uh, provide dandy healthcare to the governing elite, but it can’t be trusted with administering the healthcare for the rest of us.

Baloney Hillary. Just lost my vote.

read part 1

The Free Pursuit of Happiness

We could argue that all of the positive effects of moderate intoxicant use would be better achieved through such practices as prayer, meditation, good works and simple clean living. At the same time, all of the obvious negative effects of intoxicant overuse and abuse would best be avoided altogether. So we might all be better off, and better people, if society just eliminated the use of all intoxicants. There are some individuals who have already achieved such purity; it might indeed be a better world if everyone did likewise.

But which is the better path to such a world? Prohibition, moral‑mongering, judgment and punishment? Or freedom, individual responsibility, education and growth.

We are gradually coming to understand that human beings learn better when treated with respect, given the truth, and encouraged to make intelligent choices. Positive reinforcements work better than negative conditioning. People of all ages grow more sound and vigorously while in the free pursuit of happiness than while reacting to threats and punishments.

Simply stated, the free pursuit of happiness works. To the extent that intoxicant use is truly enhancing one’s happiness, it is enough to gratefully enjoy such use and all that it brings. When instead one is overusing or abusing, and thus diminishing happiness, the challenge is to learn, to moderate present and future behavior, and to get one’s life moving on a more positive track.

Society’s challenge, in turn, is to provide an environment in which such positive learning and growth is strongly supported. This means taking all of the immense effort and resources of our failed war against drugs and shifting to a policy of honest education, compassionate treatment, and reasonable regulation. This means, in essence, becoming fully committed as a society to the basic entitlements of life, liberty and the pursuit of happiness.

read part 1

Overuse

No major American decision was ever made without the influence of alcohol, nicotine or caffeine­‑often all three. —Peter McWilliams

Yet all intoxicants can be overused. This is the ‘tox” in intoxication. Use any intoxicant too much or too often and its positive promise invariably turns poisonous.

The overuse of any intoxicant has a temporarily sickening effect upon one’s body and mind. The stumbling stupidity of too much alcohol, the hacking cough of too much tobacco, the wired agitation of too much coffee, the glazed over eyes of too much marijuana: any intoxicant can be overused and such overuse always results in a short term loss of wellness.

It must be noted, however, that our experiences with specific intoxicants are subjectively determined and therefore personal. One person’s happiness enhancer is another person’s poison. Some people can derive pleasure from scotch, some can’t. Some people can enjoy chocolate every day, some shouldn’t. Even for the individual, moderate use at one time in one’s life might constitute overuse or abuse at another time. All of which argues for social policies that encourage individual responsibility, rather than the promulgation of oppressive dogma and fruitless punishment.

The effects of intoxicant overuse are mostly temporary. They serve as clear feedback to help the individual to moderate any future use of the intoxicant. In some cases, a single instance of overuse (or even just witnessing overuse by another person) may be enough dissuade the individual from ever using a certain intoxicant. Or, some experience with overuse may lead to moderate use, ie, “I never drink more than one beer or “I only get high on weekends.” Or, the individual may miss the lessons of overuse and fall into destructive abuse.

As a species, we will continue to play with half a deck as long as we continue to tolerate cardinals of government and science who presume to dictate where human curiosity can legitimately focus its attention and where it cannot. Such restrictions on the human imagination are demeaning and preposterous. —Terrence McKenna

Lately there have been several articles in the mainstream press discussing the merits of legalizing marijuana and other intoxicants. While most politicians remain obdurate on the subject, the mere possibility of having a frank and spirited public debate, free of “just say no,” knee‑jerk hysteria, is encouraging.

This article is not an advocacy of intoxicant use, nor a denial of the very real problems of abuse and addiction. It is a plea for consistent, humane, and effective substance use and abuse policies. Our current policies inflict unnecessary suffering — on users, abusers and nonusers — while utterly failing to reduce substance abuse and addiction. It is time to try something different; let’s wind down the drug war and get on with the more rewarding work of teaching tolerance and the free pursuit of happiness.

For clarity’s sake this article is limited to a discussion of intoxicating substances. These same arguments can also be applied to the use, overuse and abuse of certain intoxicating activities, such as having sex, watching television, gambling, wielding power, and spending money.

About 80% of all births worldwide are attended by midwives. In America, some 10,000 midwives attend 5% of all births. —”Mothering” Fall 1995In 1979, [California] appropriated $750,000 for the first scientific study ever made of the root causes of violence. Two years later a first paper was issued, listing the ten principle causes of crime and violence in our nation. At the top of the list was the violent way we bring our children into the world. —Joseph Chilton Pearce

For most of human history, the two primary causes of premature death have been traumatic injury and infectious disease. Mainstream American medicine, with its heavy emphasis on hardcare practices, grew out of the challenge to solve these two problems. To a great extent it succeeded, with at times miraculous results. Yet the development of hardcare — a combination of complex diagnostic technologies followed by treatments of drugs and/or surgery — has come with unintended consequences that have brought American society to a profound crisis.

Hardcare medicine creates a specialized class of experts to administer to the sick while diminishing individual responsibility for the health of one’s body and mind. Hardcare drugs and surgeries can cause serious side-effects, often worse than the symptoms they attempt to cure. Hardcare treatments prove inadequate against a host of modern illnesses, yet hardcare tends to screen out, deny, and actively campaign against other healing approaches. Finally, hardcare medicine is extremely expensive and thus exacerbates all of our current economic difficulties.

The failings of hardcare medicine have arisen where it has over-reached its ability and over-stated its role within society. Though hardcare medicine provides excellent tools for dealing with the problems of traumatic injury and infectious disease, it fails terribly for most other health problems.

Something’s wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries. —Dr Christopher Murray, head of the Institute of Health Metrics and Evaluation, University of Washington

It’s getting to be old news, but a recent study has further clarified the dismal performance of the US healthcare system. In the past twenty years, the US has fallen from 11th to 42nd place in life expectancy. Nations doing better than America include all of Europe, Japan, Singapore, and Jordan.

Researchers cite two main factors: the ridiculous costs of health insurance, and the trend toward obesity in America, especially among the poor.

Neither of these factors will ever improve as long as we continue down the hardcare path. Indeed, both factors would be immediately improved by a shift to a single-payer system that stresses prevention and softcare.

As he retired from office, Dwight Eisenhower imparted a scary warning about the “military-industrial complex”: an insidious merging of America’s security apparatus with private and corporate profiteers that gobbles up vast national resources while spewing waste and destruction in its wake. (Early drafts used the term military-industrial-congressional complex, but the President was persuaded to remove “congressional.”) Though there’s long been much nodding in agreement with Ike’s assessment, nothing has slowed the growth or dimmed the power of the military-industrial complex.

In 1971, President Nixon declared a “war on cancer,” promising a cure with the decade. Like the current president, Nixon totally misunderstood the “enemy” and committed the nation to an endless war of attrition and frustration. Even worse, he committed vast amounts of wealth to the funding of the “medical-congressional-industrial complex” that, like its military counterpart, drains the public treasury while providing a too often unhealthy medical product.

These mammoth conglomerates share a number of traits:

During the 14th century the bubonic plague struck with devastating results, wiping out half of the population of Europe and much of Asia. Called the Black Death, it was caused by an infectious bacterium which was spread by flea-infested rats.

I can remember as a child watching a movie about that time and being struck by one scene in particular: a big man, all dressed in black, drives a cart from house to house, picking up the dead and carrying them off for burial. I remember thinking, “How is he getting away with this?” Here is an incredibly bad bug, killing one out of every two people, and this guy is going into infected households, and touching infected bodies, and somehow still managing to put in a sixteen hour day!

“We will never solve our problems using the same kind of thinking
that caused them in the first place.” —Albert Einstein

The healthcare debate of the past few years must have Einstein nodding sagely from the grave. For all the volumes that have been written, for all the legislative starts and stops, for all the heated discussions of experts and pundits, little has been said about the medical thinking that underlies our current healthcare crisis. We have fixated on the secondary concerns of administrative bureaucracies and payment systems, when we should be exploring long-overdue changes in societal attitudes, lifestyles, and healing practices.

American medicine grew out of and remains mired in the Industrial Age. The “kind of thinking” that characterizes an industrializing society is reflected throughout our current healthcare system:

• the turning of “healthcare” into a mass-produced consumer item; the imbalanced relationship between so many doctors and their patients;
• the overuse and abuse of invasive drugs and surgeries;
• the shifting of power and prestige from general practitioners to overpaid specialists;
• the discounting of mental, emotional, and nutritional causes of illness;
• the over-medicalizing of the should-be sacred events of birth and death;
• the granting of ultimate authority to distant, profit-driven bureaucrats;
• the fundamental dis-ease of the modern hospital;
• and the continuing failure to see polluted air, water, and soil as vital public health issues