A “Proud American” Male
I was thinking about the meaning of some “Labels” that we use in our society such as: Patriotism, Proud American, Courage, Loyal, Real American, Real Man, etc. What came up for me was that our society uses the above words not always as a sincere compliment, but as a convenient method of: vilifying, demonizing, manipulating, approving of, controlling, motivating, patronizing, and judging others.
As a “Proud American” male I prefer to think of myself in the model of: hard work, self reliance, compassion, fairness, integrity, service to others, generosity, kindness, and forgiveness. It would be difficult for me to be to feel “Proud” if I modeled myself on: selfishness, narcissism, apathy, intolerance, arrogance, insolence, blind allegiance to any government or religion.
Definition of “Proud” in Webster’s Dictionary- feeling or showing pride; having or displaying excessive self esteem; much pleased; having self respect.
Synonyms for “Proud” – arrogant; haughty; lordly; insolent; overbearing; supercilious; disdainful.
I am trying very hard to cast myself as a consistent “Proud American” male, but through a review of our history, I come up against resistance based on the following examples:
• Denial of a women’s right to vote for 150 years up until 1920.
• Enslavement of Afro-Americans for 80 years after the Declaration of Independence, and then complicity with racist ignorant members of our population to continue to hold back opportunities in education, housing, jobs, military, and social integration.
• The systematic murder, brutalization and outright theft of land belonging to Native Americans.
• Long history of pollution, raping of the land, and general disregard for the moral stewardship of our countries land.
• We call a man a “Pussy” or “Wimp” for acting compassionately, sensitive, or non-violent. I will choose “Pussy” over war mongering, racist, homophobic, violent pig any day. But then again we don’t have a great track record for respecting the power and rights of women, ergo “Pussy”.
• Major Racism and Ignorance until the Supreme Court decision that overturned the will of the people in 1970 to make Inter-Racial Marriage illegal.
• Internment of over 100,000 loyal Japanese Americans during WWII, but no incarceration for German and Italian Americans whose native countries were also our enemies during that time period. Could this be our inherent racism and inability to accept people who did not look like us of European extraction?
• That we are one of last developed nations who is finally starting to create a structure for affordable and accessible health care. Should health care be a basic human right not included in our Capitalistic system to create profit based on human suffering? The right to be healthy should be on a level of have enough to eat, having clean air to breathe, and clean water to drink. Health care even trumps the right to housing and social human rights(not to diminish human rights).
• We have a demonstrable history of putting “Profit” and “Greed” above human rights, basic health care, a clean environment, non-warring dispute resolution.
• We are a nation of some “Narcissistic Behaviors” coupled with “Excessive Consumption”.
• The “Silent Majority” has not actively protested against the Vietnam War and the latest Iraq invasion.
• We are not enlightened enough to understand that “Gay Marriage” will not interfere with anyone else’s marriage, or that we need to stand up to repressive religious leaders, and that there is no scientific data that demonstrates that Gay Marriage will harm society. A just and non-biased Supreme Court will ultimately overturn “Prop 8”, as it justly turned down the repressive doctrine of “Separate but Equal” (Plessy v…. ) in the rightful case of Brown v. Board of Education.
• “Don’t Ask, Don’t Tell” is dishonest, hypocritical and a shameful compromise to placate some ignorant homophobic members of the military and congress.
• An attitude of “Nationalism” or as some use the word “Patriotism” that’s lets us delude ourselves into thinking that we are superior to all other nations.
• A concern that if we are too critical of our “National Behavior” that we are not true “Patriots” or “Proud Americans”. General Motors did not embark upon a focused objective program of inner criticism and as a result would be out of business if it were not for the “Bailout”. Hubris and Arrogance ultimately lead to decay, and not progress and self improvement.
• Those who say, “Love it or Leave It” is not a positive solution to growth and progress, only an “Arrogant” and “Haughty” negative retort.
I find the above examples shameful, embarrassing, and sad; and that we as a supposed “Rightful and Proud” nation conduct ourselves so inhumanely and selfishly.
A few examples of American’s we should be really proud of are:
• Dwight Eisenhower, a Republican president and military leader who had the courage and integrity to challenge the military establishment and said, “Beware of the Military Industrial Complex”.
• Martin Luther King Jr. who selflessly championed for equal rights and peace through “Non Violent Demonstrations” and ultimately lost his life due to fear and bigotry that he tried to erase.
• Thurgood Marshall who was a brilliant jurist and vocal civil rights lawyer, who could have selfishly chosen to make a lot more money doing corporate law, but chose to champion the rights of the less powerful and disadvantaged.
• Those people who championed for human rights, and as a result were vilified as “Communists” during the McCarthy era.
• Abraham Lincoln, Bobby Kennedy, and Lyndon Johnson who went against the political tide to champion for human rights and freedom.
• The “Minority” of Americans on all strata’s of the political and social spectrum who non-violently protested, because they cared and understood that the biggest threat to a democracy was not the Politicians, but the “Silent Uninformed Majority”.
• Those American’s who volunteer their time and/or money giving free service to improve: education, health, and alleviate human suffering.
• Those who see that we have an “Abundant Universe” and conduct themselves accordingly.
There also a great deal of wonderful attributes that the people of our country possess:
Positive thinking, resolve, hard work, focus, creativity, courage, compassion, tolerance, diversity, generosity, and forgiveness
Through “Constructive Self Criticism” we can build on the wonderful attributes of America, and leave the “Repressive Dysfunctional Old World Traditions and Thinking” behind us.
Sunday, December 27, 2009
Thursday, October 1, 2009
My Favorite Quotes
If your not taking a risk in life, your just taking up space!
-H. Rifkin
Why is that, those with "Simple Minds" who often lack Compassion, try to find Simple narrow answers that usually don't address the Complex questions?
-H. Rifkin
Through time people who lacked vision, feared change, and were mired in ignorance tried to block progress and enlightenment, but fortunately those with courage, vision, patience and sted-fastness prevailed for the general benefit of humanity.
-H. Rifkin
You cannot experience love and fear at the same time! May every step you take be one of forgiveness!
-Attitudinal Healing
History will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people.
-Martin Luther King, Jr.
Many people have ideas on how others should change; few people have ideas on how they should change.
- Tolstoy
"An eye for an eye" leaves the whole world blind.
- Mahatma Ghandi
Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world.
- Albert Einstein
An injustice anywhere is a threat to justice eveywhere.
-Martin Luther King, Jr.
Man invented god, not the other way around.
-Carl Reiner
-H. Rifkin
Why is that, those with "Simple Minds" who often lack Compassion, try to find Simple narrow answers that usually don't address the Complex questions?
-H. Rifkin
Through time people who lacked vision, feared change, and were mired in ignorance tried to block progress and enlightenment, but fortunately those with courage, vision, patience and sted-fastness prevailed for the general benefit of humanity.
-H. Rifkin
You cannot experience love and fear at the same time! May every step you take be one of forgiveness!
-Attitudinal Healing
History will have to record that the greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people.
-Martin Luther King, Jr.
Many people have ideas on how others should change; few people have ideas on how they should change.
- Tolstoy
"An eye for an eye" leaves the whole world blind.
- Mahatma Ghandi
Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world.
- Albert Einstein
An injustice anywhere is a threat to justice eveywhere.
-Martin Luther King, Jr.
Man invented god, not the other way around.
-Carl Reiner
Sunday, September 20, 2009
REPUBLICANS vs. DEMOCRATS ON THE ECONOMY
May 9, 2005
By: Kevin Drum
http://www.washingtonmonthly.com/archives/individual/2005_05/006282.php
REPUBLICANS vs. DEMOCRATS ON THE ECONOMY....Did you know that Democratic presidents are better for the economy than Republicans? Sure you did. I pointed this out two years ago, back when my readership numbered in the dozens, and more recently Michael Kinsley ran the numbers in the LA Times and came to the same conclusion.
The results are simple: Democratic presidents have consistently higher economic growth and consistently lower unemployment than Republican presidents. If you add in a time lag, you get the same result. If you eliminate the best and worst presidents, you get the same result. If you take a look at other economic indicators, you get the same result. There's just no way around it: Democratic administrations are better for the economy than Republican administrations.
Skeptics offer two arguments: first, that presidents don't control the economy; second, that there are too few data points to draw any firm conclusions. Neither argument is convincing. It's true that presidents don't control the economy, but they do influence it — as everyone tacitly acknowledges by fighting like crazed banshees over every facet of fiscal policy ever offered up by a president.
The second argument doesn't hold water either. The dataset that delivers these results now covers more than 50 years, 10 administrations, and half a dozen different measures. That's a fair amount of data, and the results are awesomely consistent: Democrats do better no matter what you measure, how you measure it, or how you fiddle with the data.
But it turns out there's more to this. Via Brendan Nyhan, I recently read a paper by Princeton's Larry Bartels that adds some fascinating details to this picture.
--------------------------------------------------------------------------------
The first thing Bartels did was break down economic performance by income class. The unsurprising result is shown in the chart on the right.
Under Democratic presidents, every income class did well but the poorest did best. The bottom 20% had average pretax income growth of 2.63% per year while the top 5% showed pretax income growth of 2.11% per year.
Republicans were polar opposites. Not only was their overall performance worse than Democrats, but it was wildly tilted toward the well off. The bottom 20% saw pretax income growth of only .6% per year while the top 5% enjoyed pretax income growth of 2.09% per year. (What's more, the trendline is pretty clear: if the chart were extended to show the really rich — the top 1% and the top .1% — the Republican growth numbers for them would be higher than the Democratic numbers.)
In other words, Republican presidents produce poor economic performance because they're obsessed with helping the well off. Their focus is on the wealthiest 5%, and the numbers show it. At least 95% of the country does better under Democrats.
--------------------------------------------------------------------------------
But this raises an interesting question: if 95% of the country does better under Democrats, and if economic performance is the most important factor in most presidential elections, then how do Republicans ever get elected? The most common hypothesis — spelled out in detail in last year's What's The Matter With Kansas? — is that cultural issues often override economic considerations. But Bartels proposes a surprising alternative explanation illustrated in the two charts below. The top chart shows income growth during non-election years, and it displays the usual characteristics: under Democrats, income growth is strong overall and the poor do a bit better than the well off. Under Republicans, income growth is weak overall and is tilted heavily in favor of the already prosperous.
But now look at the bottom chart. It shows economic performance during election years and it's a mirror image of the top chart: Republicans produce better overall performance, and they produce especially stupendous performance for the well off. Democrats not only produce poor overall performance, they produce disastrous performance for the well off, who actually have negative income growth.
In other words, voters aren't necessarily ignoring economic issues in favor of cultural issues. Rather, Republicans produce great economic growth for all income classes in election years, and that's all that voters remember. They really are voting their pocketbooks.
Bartels doesn't essay an explanation for this. Do Republican presidents deliberately try to time economic growth spurts — and are Democratic presidents too lame to do the same? Is it just luck? Or is the difference somehow inherent in the different ways that Democrats and Republicans approach the economy (with Democrats typically focusing on employment and Republicans on inflation)? At this point, your guess is as good as anyone's.
Bottom line: if you're well off, vote for Republicans. But if you make less than $150,000 a year, Republicans are your friends only one year in four. Caveat emptor.
By: Kevin Drum
http://www.washingtonmonthly.com/archives/individual/2005_05/006282.php
REPUBLICANS vs. DEMOCRATS ON THE ECONOMY....Did you know that Democratic presidents are better for the economy than Republicans? Sure you did. I pointed this out two years ago, back when my readership numbered in the dozens, and more recently Michael Kinsley ran the numbers in the LA Times and came to the same conclusion.
The results are simple: Democratic presidents have consistently higher economic growth and consistently lower unemployment than Republican presidents. If you add in a time lag, you get the same result. If you eliminate the best and worst presidents, you get the same result. If you take a look at other economic indicators, you get the same result. There's just no way around it: Democratic administrations are better for the economy than Republican administrations.
Skeptics offer two arguments: first, that presidents don't control the economy; second, that there are too few data points to draw any firm conclusions. Neither argument is convincing. It's true that presidents don't control the economy, but they do influence it — as everyone tacitly acknowledges by fighting like crazed banshees over every facet of fiscal policy ever offered up by a president.
The second argument doesn't hold water either. The dataset that delivers these results now covers more than 50 years, 10 administrations, and half a dozen different measures. That's a fair amount of data, and the results are awesomely consistent: Democrats do better no matter what you measure, how you measure it, or how you fiddle with the data.
But it turns out there's more to this. Via Brendan Nyhan, I recently read a paper by Princeton's Larry Bartels that adds some fascinating details to this picture.
--------------------------------------------------------------------------------
The first thing Bartels did was break down economic performance by income class. The unsurprising result is shown in the chart on the right.
Under Democratic presidents, every income class did well but the poorest did best. The bottom 20% had average pretax income growth of 2.63% per year while the top 5% showed pretax income growth of 2.11% per year.
Republicans were polar opposites. Not only was their overall performance worse than Democrats, but it was wildly tilted toward the well off. The bottom 20% saw pretax income growth of only .6% per year while the top 5% enjoyed pretax income growth of 2.09% per year. (What's more, the trendline is pretty clear: if the chart were extended to show the really rich — the top 1% and the top .1% — the Republican growth numbers for them would be higher than the Democratic numbers.)
In other words, Republican presidents produce poor economic performance because they're obsessed with helping the well off. Their focus is on the wealthiest 5%, and the numbers show it. At least 95% of the country does better under Democrats.
--------------------------------------------------------------------------------
But this raises an interesting question: if 95% of the country does better under Democrats, and if economic performance is the most important factor in most presidential elections, then how do Republicans ever get elected? The most common hypothesis — spelled out in detail in last year's What's The Matter With Kansas? — is that cultural issues often override economic considerations. But Bartels proposes a surprising alternative explanation illustrated in the two charts below. The top chart shows income growth during non-election years, and it displays the usual characteristics: under Democrats, income growth is strong overall and the poor do a bit better than the well off. Under Republicans, income growth is weak overall and is tilted heavily in favor of the already prosperous.
But now look at the bottom chart. It shows economic performance during election years and it's a mirror image of the top chart: Republicans produce better overall performance, and they produce especially stupendous performance for the well off. Democrats not only produce poor overall performance, they produce disastrous performance for the well off, who actually have negative income growth.
In other words, voters aren't necessarily ignoring economic issues in favor of cultural issues. Rather, Republicans produce great economic growth for all income classes in election years, and that's all that voters remember. They really are voting their pocketbooks.
Bartels doesn't essay an explanation for this. Do Republican presidents deliberately try to time economic growth spurts — and are Democratic presidents too lame to do the same? Is it just luck? Or is the difference somehow inherent in the different ways that Democrats and Republicans approach the economy (with Democrats typically focusing on employment and Republicans on inflation)? At this point, your guess is as good as anyone's.
Bottom line: if you're well off, vote for Republicans. But if you make less than $150,000 a year, Republicans are your friends only one year in four. Caveat emptor.
Saturday, September 19, 2009
You can't complain about health care reform if you're not willing to reform your own health
Quote from Bill Maher - New Rule: You can't complain about health care reform if you're not willing to reform your own health. Unlike most liberals, I'm glad all those teabaggers marched on Washington last week. Because judging from the photos, it's the first exercise they've gotten in years. Not counting, of course, all the Rascal scooters there, most of which aren't even for the disabled. They're just Americans who turned 60 and said, "Screw it, I'm done walking." These people are furious at the high cost of health care, so they blame illegals, who don't even get health care. News flash, Glenn Beck fans: the reason health care is so expensive is because you're all so unhealthy.
Yes, it was fun this week to watch the teabaggers complain how the media underestimated the size of their march, "How can you say there were only 60,000 of us? We filled the entire mall!" Yes, because you're fat. One whale fills the tank at Sea World, that doesn't make it a crowd.
President Obama has identified all the problems with the health care system, but there's one tiny issue he refuses to tackle, and that's our actual health.
And since Americans can only be prodded into doing something with money, we need to tax crappy foods that make us sick like we do with cigarettes, and alcohol -- and alcohol actually serves a useful function in society in that it enables unattractive people to get laid, which is more than you can say for Skittles.
I'm not saying tax all soda, but certainly any single serving of soda larger than a baby is not unreasonable. If you don't know whether you burp it or it burps you, that's too big. We need to make taking care of ourselves an issue of patriotism. If you were someone who condemned Bush for not asking Americans to sacrifice for the war on terror, the same must be said for Obama and health care.
President Arugula is not gonna tell Americans they're fat and lazy. No sin tax on food on Obama's watch. And at a time when it's important to set new standards for personal responsibility, he appointed a surgeon general, who is, I'm sorry, kind of fat. Certainly too heavy to be a surgeon general, it's a role model thing. It would be like appointing a Secretary of the Treasury who didn't pay his taxes. He did?
And get this: Surgeon General Benjamin had previously been a nutritional advisor to Burger King. The only advice a "health expert" should give Burger King is to stop selling food. The "nutritional advisor" job was described as, "promoting balanced diets and active lifestyle choices" -- and who better to do that than the folks who hand you meat and corn syrup through a car window? When you have a surgeon general who comes from Burger King, it's a message to lobbyists, and that message is, "Have it your way."
Read more at: http://www.huffingtonpost.com/bill-maher/new-rule-you-cant-complai_b_291852.html
Yes, it was fun this week to watch the teabaggers complain how the media underestimated the size of their march, "How can you say there were only 60,000 of us? We filled the entire mall!" Yes, because you're fat. One whale fills the tank at Sea World, that doesn't make it a crowd.
President Obama has identified all the problems with the health care system, but there's one tiny issue he refuses to tackle, and that's our actual health.
And since Americans can only be prodded into doing something with money, we need to tax crappy foods that make us sick like we do with cigarettes, and alcohol -- and alcohol actually serves a useful function in society in that it enables unattractive people to get laid, which is more than you can say for Skittles.
I'm not saying tax all soda, but certainly any single serving of soda larger than a baby is not unreasonable. If you don't know whether you burp it or it burps you, that's too big. We need to make taking care of ourselves an issue of patriotism. If you were someone who condemned Bush for not asking Americans to sacrifice for the war on terror, the same must be said for Obama and health care.
President Arugula is not gonna tell Americans they're fat and lazy. No sin tax on food on Obama's watch. And at a time when it's important to set new standards for personal responsibility, he appointed a surgeon general, who is, I'm sorry, kind of fat. Certainly too heavy to be a surgeon general, it's a role model thing. It would be like appointing a Secretary of the Treasury who didn't pay his taxes. He did?
And get this: Surgeon General Benjamin had previously been a nutritional advisor to Burger King. The only advice a "health expert" should give Burger King is to stop selling food. The "nutritional advisor" job was described as, "promoting balanced diets and active lifestyle choices" -- and who better to do that than the folks who hand you meat and corn syrup through a car window? When you have a surgeon general who comes from Burger King, it's a message to lobbyists, and that message is, "Have it your way."
Read more at: http://www.huffingtonpost.com/bill-maher/new-rule-you-cant-complai_b_291852.html
Friday, September 18, 2009
Harvard Study: Lack of Insurance Causes 45,000 Deaths Every Year
New York Times:
As the White House and Congress continue debating how best to provide coverage to tens of millions of Americans currently without health insurance, a new study (PDF) is meant to offer a stark reminder of why lawmakers should continue to try. Researchers from Harvard Medical School say the lack of coverage can be tied to about 45,000 deaths a year in the United States — a toll that is greater than the number of people who die each year from kidney disease.
“If you extend coverage, you can save lives,” said Dr. Steffie Woolhandler, a professor of medicine at Harvard who is one of the study’s authors. The research is being published in the December issue of the American Journal of Public Health and was posted online Thursday.
The Harvard study found that people without health insurance had a 40 percent higher risk of death than those with private health insurance — as a result of being unable to obtain necessary medical care. The risk appears to have increased since 1993, when a similar study found the risk of death was 25 percent greater for the uninsured.
The increase in risk, according to the study, is likely to be a result of at least two factors. One is the greater difficulty the uninsured have today in finding care, as public hospitals have closed or cut back on services. The other is improvements in medical care for insured people with treatable chronic conditions like high blood pressure.
As the White House and Congress continue debating how best to provide coverage to tens of millions of Americans currently without health insurance, a new study (PDF) is meant to offer a stark reminder of why lawmakers should continue to try. Researchers from Harvard Medical School say the lack of coverage can be tied to about 45,000 deaths a year in the United States — a toll that is greater than the number of people who die each year from kidney disease.
“If you extend coverage, you can save lives,” said Dr. Steffie Woolhandler, a professor of medicine at Harvard who is one of the study’s authors. The research is being published in the December issue of the American Journal of Public Health and was posted online Thursday.
The Harvard study found that people without health insurance had a 40 percent higher risk of death than those with private health insurance — as a result of being unable to obtain necessary medical care. The risk appears to have increased since 1993, when a similar study found the risk of death was 25 percent greater for the uninsured.
The increase in risk, according to the study, is likely to be a result of at least two factors. One is the greater difficulty the uninsured have today in finding care, as public hospitals have closed or cut back on services. The other is improvements in medical care for insured people with treatable chronic conditions like high blood pressure.
The Body Count at Home
Published: September 12, 2009
In the debate over health care, here’s an inequity to ponder: Nikki White would have been far better off if only she had been a convicted bank robber.
Skip to next paragraph
Fred R. Conrad/The New York Times
Nicholas D. Kristof
On the Ground
Nicholas Kristof addresses reader feedback and posts short takes from his travels.
Go to Blog » Go to Columnist Page »
Related
Times Topics: Health Care Reform
Courtesy of Nikki White's Family
Nikki White died at the age of 32. She had lupus, a chronic inflammatory disease that was untreated because she could not afford health insurance.
Nikki was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.
In any other rich country, Nikki probably would have been fine, notes T. R. Reid in his important and powerful new book, “The Healing of America.” Some 80 percent of lupus patients in the United States live a normal life span. Under a doctor’s care, lupus should be manageable. Indeed, if Nikki had been a felon, the problem could have been averted, because courts have ruled that prisoners are entitled to medical care.
As Mr. Reid recounts, Nikki tried everything to get medical care, but no insurance company would accept someone with her pre-existing condition. She spent months painfully writing letters to anyone she thought might be able to help. She fought tenaciously for her life.
Finally, Nikki collapsed at her home in Tennessee and was rushed to a hospital emergency room, which was then required to treat her without payment until her condition stabilized. Since money was no longer an issue, the hospital performed 25 emergency surgeries on Nikki, and she spent six months in critical care.
“When Nikki showed up at the emergency room, she received the best of care, and the hospital spent hundreds of thousands of dollars on her,” her step-father, Tony Deal, told me. “But that’s not when she needed the care.”
By then it was too late. In 2006, Nikki White died at age 32. “Nikki didn’t die from lupus,” her doctor, Amylyn Crawford, told Mr. Reid. “Nikki died from complications of the failing American health care system.”
“She fell through the cracks,” Nikki’s mother, Gail Deal, told me grimly. “When you bury a child, it’s the worst thing in the world. You never recover.”
We now have a chance to reform this cruel and capricious system. If we let that chance slip away, there will be another Nikki dying every half-hour.
That’s how often someone dies in America because of a lack of insurance, according to a study by a branch of the National Academy of Sciences. Over a year, that amounts to 18,000 American deaths.
After Al Qaeda killed nearly 3,000 Americans, eight years ago on Friday, we went to war and spent hundreds of billions of dollars ensuring that this would not happen again. Yet every two months, that many people die because of our failure to provide universal insurance — and yet many members of Congress want us to do nothing?
Mr. Reid’s book is a rich tour of health care around the world. Because he has a bum shoulder, he asked doctors in many countries to examine it and make recommendations. His American orthopedist recommended a titanium shoulder replacement that would cost tens of thousands of dollars and might or might not help. Specialists in other countries warned that a sore shoulder didn’t justify the risks of such major surgery, although some said it would be available free if Mr. Reid insisted. Instead, they offered physical therapy, acupuncture and other cheap and noninvasive alternatives, some of which worked pretty well.
That’s a window into the flaws in our health care system: we offer titanium shoulder replacements for those who don’t really need them, but we let 32-year-old women die if they lose their health insurance. No wonder we spend so much on medical care, and yet have some health care statistics that are worse than Slovenia’s.
My suggestion for anyone in Nikki’s situation: commit a crime and get locked up. In Washington State, a 20-year-old inmate named Melissa Matthews chose to turn down parole and stay in prison because that was the only way she could get treatment for her cervical cancer. “If I’m out, I’m going to die from this cancer,” she told a television station.
Mr. and Mrs. Deal say they are speaking out because Nikki wouldn’t want anyone to endure what she did. “Nikki was a college-educated, middle-class woman, and if it could happen to her, it can happen to anyone,” Mr. Deal said. “This should not be happening in our country.”
Struggling to get out the words, Mrs. Deal added: “The loss of a child is the greatest hurt anyone will ever suffer. Because of the circumstances she endured with the health care system, I lost my daughter.”
Complex arguments are being batted around in this health care debate, but the central issue isn’t technical but moral. The first question is simply this: Do we wish to be the only rich nation in the world that lets a 32-year-old woman die because she can’t get health insurance? Is that really us?
In the debate over health care, here’s an inequity to ponder: Nikki White would have been far better off if only she had been a convicted bank robber.
Skip to next paragraph
Fred R. Conrad/The New York Times
Nicholas D. Kristof
On the Ground
Nicholas Kristof addresses reader feedback and posts short takes from his travels.
Go to Blog » Go to Columnist Page »
Related
Times Topics: Health Care Reform
Courtesy of Nikki White's Family
Nikki White died at the age of 32. She had lupus, a chronic inflammatory disease that was untreated because she could not afford health insurance.
Nikki was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.
In any other rich country, Nikki probably would have been fine, notes T. R. Reid in his important and powerful new book, “The Healing of America.” Some 80 percent of lupus patients in the United States live a normal life span. Under a doctor’s care, lupus should be manageable. Indeed, if Nikki had been a felon, the problem could have been averted, because courts have ruled that prisoners are entitled to medical care.
As Mr. Reid recounts, Nikki tried everything to get medical care, but no insurance company would accept someone with her pre-existing condition. She spent months painfully writing letters to anyone she thought might be able to help. She fought tenaciously for her life.
Finally, Nikki collapsed at her home in Tennessee and was rushed to a hospital emergency room, which was then required to treat her without payment until her condition stabilized. Since money was no longer an issue, the hospital performed 25 emergency surgeries on Nikki, and she spent six months in critical care.
“When Nikki showed up at the emergency room, she received the best of care, and the hospital spent hundreds of thousands of dollars on her,” her step-father, Tony Deal, told me. “But that’s not when she needed the care.”
By then it was too late. In 2006, Nikki White died at age 32. “Nikki didn’t die from lupus,” her doctor, Amylyn Crawford, told Mr. Reid. “Nikki died from complications of the failing American health care system.”
“She fell through the cracks,” Nikki’s mother, Gail Deal, told me grimly. “When you bury a child, it’s the worst thing in the world. You never recover.”
We now have a chance to reform this cruel and capricious system. If we let that chance slip away, there will be another Nikki dying every half-hour.
That’s how often someone dies in America because of a lack of insurance, according to a study by a branch of the National Academy of Sciences. Over a year, that amounts to 18,000 American deaths.
After Al Qaeda killed nearly 3,000 Americans, eight years ago on Friday, we went to war and spent hundreds of billions of dollars ensuring that this would not happen again. Yet every two months, that many people die because of our failure to provide universal insurance — and yet many members of Congress want us to do nothing?
Mr. Reid’s book is a rich tour of health care around the world. Because he has a bum shoulder, he asked doctors in many countries to examine it and make recommendations. His American orthopedist recommended a titanium shoulder replacement that would cost tens of thousands of dollars and might or might not help. Specialists in other countries warned that a sore shoulder didn’t justify the risks of such major surgery, although some said it would be available free if Mr. Reid insisted. Instead, they offered physical therapy, acupuncture and other cheap and noninvasive alternatives, some of which worked pretty well.
That’s a window into the flaws in our health care system: we offer titanium shoulder replacements for those who don’t really need them, but we let 32-year-old women die if they lose their health insurance. No wonder we spend so much on medical care, and yet have some health care statistics that are worse than Slovenia’s.
My suggestion for anyone in Nikki’s situation: commit a crime and get locked up. In Washington State, a 20-year-old inmate named Melissa Matthews chose to turn down parole and stay in prison because that was the only way she could get treatment for her cervical cancer. “If I’m out, I’m going to die from this cancer,” she told a television station.
Mr. and Mrs. Deal say they are speaking out because Nikki wouldn’t want anyone to endure what she did. “Nikki was a college-educated, middle-class woman, and if it could happen to her, it can happen to anyone,” Mr. Deal said. “This should not be happening in our country.”
Struggling to get out the words, Mrs. Deal added: “The loss of a child is the greatest hurt anyone will ever suffer. Because of the circumstances she endured with the health care system, I lost my daughter.”
Complex arguments are being batted around in this health care debate, but the central issue isn’t technical but moral. The first question is simply this: Do we wish to be the only rich nation in the world that lets a 32-year-old woman die because she can’t get health insurance? Is that really us?
Thursday, September 17, 2009
Right Wing Fringe Lunatics
Rachel Maddow talks to Frank Schaeffer about why a good deal of conservatives when polled said they weren't sure if President Obama was the anti-Christ.
Maddow: I do not know what possessed this polling firm to ask whether or not that people think the President is the anti-Christ, but they did. Does the response rate among conservatives surprise you? More than one in three saying yes or they don’t know.
Schaeffer: Well I was a child when President Kennedy was assassinated and my mother thought that because he died of a head wound foretold in scriptures of the anti-Christ he would be resurrected as the anti-Christ. She thought this might be a possibility. So those of us who come from the evangelical subculture have been weaned with our mother’s milk on a changing case list of villains. It might be Kennedy to one generation, Obama to the next.
But the larger point this brings up is that the mainstream not just media but culture doesn’t sufficiently take stock of the fact that within our culture we have a subculture which is literally a fifth column of insanity that is bred from birth, through home school, Christian school, evangelical college, whatever to reject facts as a matter of faith.
And so this substitute for authentic historic Christianity, and I may add as a little caveat here, I’m a church-going Christian, really brings up the question. Can Christianity be rescued from Christians? And that’s an open question. And when you see a bunch of people going around thinking that our President if the anti-Christ you have to draw one of two conclusions.
Either these are racists looking for any excuse to level the next accusation or they’re beyond crazy. And I think beyond crazy is a better explanation and that evangelical subculture has rotted the brain of the United States of America. We have a big slice of our population waiting for Jesus to come back. They look forward to Armageddon. Good news is bad news to them. We talk about the Left Behind series of books that I talk about in my book Crazy for God.
What we’re really talking about is a group of people are resentful because they know they’ve been left behind by modernity, by science, by education, by art, by literature—the rest of us are getting on with our lives. These people are standing on a hill top waiting for the end and this is a dangerous group of people to have as neighbors. And they’re our national neighbors. And this is the source of all these insanities that we see leveled at the President. One way or the other they go back to this little evangelical subculture.
Maddow: I do not know what possessed this polling firm to ask whether or not that people think the President is the anti-Christ, but they did. Does the response rate among conservatives surprise you? More than one in three saying yes or they don’t know.
Schaeffer: Well I was a child when President Kennedy was assassinated and my mother thought that because he died of a head wound foretold in scriptures of the anti-Christ he would be resurrected as the anti-Christ. She thought this might be a possibility. So those of us who come from the evangelical subculture have been weaned with our mother’s milk on a changing case list of villains. It might be Kennedy to one generation, Obama to the next.
But the larger point this brings up is that the mainstream not just media but culture doesn’t sufficiently take stock of the fact that within our culture we have a subculture which is literally a fifth column of insanity that is bred from birth, through home school, Christian school, evangelical college, whatever to reject facts as a matter of faith.
And so this substitute for authentic historic Christianity, and I may add as a little caveat here, I’m a church-going Christian, really brings up the question. Can Christianity be rescued from Christians? And that’s an open question. And when you see a bunch of people going around thinking that our President if the anti-Christ you have to draw one of two conclusions.
Either these are racists looking for any excuse to level the next accusation or they’re beyond crazy. And I think beyond crazy is a better explanation and that evangelical subculture has rotted the brain of the United States of America. We have a big slice of our population waiting for Jesus to come back. They look forward to Armageddon. Good news is bad news to them. We talk about the Left Behind series of books that I talk about in my book Crazy for God.
What we’re really talking about is a group of people are resentful because they know they’ve been left behind by modernity, by science, by education, by art, by literature—the rest of us are getting on with our lives. These people are standing on a hill top waiting for the end and this is a dangerous group of people to have as neighbors. And they’re our national neighbors. And this is the source of all these insanities that we see leveled at the President. One way or the other they go back to this little evangelical subculture.
Wednesday, September 16, 2009
Why so much Obama Opposition?
From my perception I have never seen the degree of vitriol and resistance to a Democratic president of the US , even going back to Truman. I am curious why this negativity is happening to such a great degree to Obama, compared to other past presidents.
I am doing my own survey. In your estimation and from your vantage point, what number [1 through 5, where 5 is the strongest] would you attribute to the following Obama resistance factors?
Please take a moment of your time to respond. Thank you for your time.
____Democrat
____Moderate Liberal
____Black Man
____Too Intellectual
____ The “Socialism” bad word
____General fear of change due to the strained economy
____He has a legislative branch where the majority party generally agrees with his policies
____Distant, not folksy enough
_____Other Factors such as_________________________________________________________________________________
I am doing my own survey. In your estimation and from your vantage point, what number [1 through 5, where 5 is the strongest] would you attribute to the following Obama resistance factors?
Please take a moment of your time to respond. Thank you for your time.
____Democrat
____Moderate Liberal
____Black Man
____Too Intellectual
____ The “Socialism” bad word
____General fear of change due to the strained economy
____He has a legislative branch where the majority party generally agrees with his policies
____Distant, not folksy enough
_____Other Factors such as_________________________________________________________________________________
A Canadian doctor diagnoses U.S. healthcare
A Canadian doctor diagnoses U.S. healthcare The caricature of 'socialized medicine' is used by corporate interests to confuse Americans and maintain their bottom lines instead of patients' health. By Michael M. Rachlis August 3, 2009 » Discuss Article (360 Comments) Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians' services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them. Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics. What's so great about private health... ADS BY GOOGLE U.S.' and Canada's different health insurance decisions make up the world's largest health policy experiment. And the results? On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays. On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year. Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems. On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can't charge as much when they have to deal with a single payer. Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices. Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower. Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead. The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease. However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two- to four-month waiting times for mammograms. On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity. These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn't happen. And perverse incentives like fee-for-service make things even worse. Using techniques like those championed by the Boston-based Institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world's best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month. Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality. U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada's, or any other nation's, experience than ever. Why? American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.
Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors. Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience. Michael M. Rachlis is a physician, health policy analyst and author in Toronto.
Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors. Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience. Michael M. Rachlis is a physician, health policy analyst and author in Toronto.
Obama's Plan to Lower Health Care Costs
BARACK OBAMA AND JOE BIDEN’S PLAN TO LOWER HEALTH CARE COSTS
AND ENSURE AFFORDABLE, ACCESSIBLE HEALTH COVERAGE FOR ALL
Health care costs are skyrocketing. Health insurance premiums have doubled in the last 8 years, rising 3.7
times faster than wages in the past 8 years, and increasing co-pays and deductibles threaten access to care.1
Many insurance plans cover only a limited number of doctors’ visits or hospital days, exposing families to
unlimited financial liability. Over half of all personal bankruptcies today are caused by medical bills.2 Lack of
affordable health care is compounded by serious flaws in our health care delivery system. About 100,000
Americans die from medical errors in hospitals every year.3 One-quarter of all medical spending goes to
administrative and overhead costs, and reliance on antiquated paper-based record and information systems
needlessly increases these costs.4
Tens of millions of Americans are uninsured because of rising costs. Over 45 million Americans5—
including over 8 million children6—lack health insurance. Eighty percent of the uninsured are in working
families.7 Even those with health coverage are struggling to cope with soaring medical costs. Skyrocketing
health care costs are making it increasingly difficult for employers, particularly small businesses, to provide
health insurance to their employees.
Underinvestment in prevention and public health. Too many Americans go without high-value preventive
services, such as cancer screening and immunizations to protect against flu or pneumonia. The nation faces
epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Yet despite
all of this less than 4 cents of every health care dollar is spent on prevention and public health.8 Our health care
system has become a disease care system, and the time for change is well overdue.
OBAMA-BIDEN PLAN TO PROVIDE AFFORDABLE, ACCESSIBLE HEALTH CARE TO ALL
Barack Obama and Joe Biden’s plan strengthens employer–based coverage, makes insurance companies
accountable and ensures patient choice of doctor and care without government interference. Under the plan, if
you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500
per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance
options.
Inefficient and poor quality care costs the nation at least $50 to $100 billion every year.9 Billions more are
wasted on administration and overhead because of inefficiencies in the health care system.10 And given current
trends, this problem will only get worse as health care spending is expected to double within the next decade.11
A growing body of research points to substantial opportunities to improve quality while reducing the costs of
care. Health care systems in many parts of the country deliver high quality care to the populations they serve at
half the cost of other equally renowned academic medical centers in other parts of the country.12 The key is to
provide information, incentives and support to help physicians and others work together to improve quality of
care while reducing costs.
Barack Obama and Joe Biden believe we must redesign our health system to reduce inefficiency and waste and
improve health care quality, which will drive down costs for families and individuals. The Obama-Biden plan
will improve efficiency and lower costs in the health care system by: (1) adopting state-of-the-art health
information technology systems; (2) ensuring that patients receive and providers deliver the best possible care,
including prevention and chronic disease management services; (3) reforming our market structure to increase
competition; and offering federal reinsurance to employers to help ensure that unexpected or catastrophic
illnesses do not make health insurance unaffordable or out of reach for businesses and their employees.
(1) INVEST IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS. Most medical records are still
stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors.
Processing paper claims also costs twice as much as processing electronic claims.13 Barack Obama and Joe
Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad
adoption of standards-based electronic health information systems, including electronic health records. They
will also phase in requirements for full implementation of health IT and commit the necessary federal resources
to make it happen. Barack Obama and Joe Biden will ensure that these systems are developed in coordination
with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe
Biden will ensure that patients’ privacy is protected. A study by the Rand Corporation found that if most
hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized
each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary
testing, more appropriate drug utilization, and other efficiencies.14
(2) IMPROVE ACCESS TO PREVENTION AND PROVEN DISEASE MANAGEMENT PROGRAMS. Experts agree that
several steps should be taken immediately to help patients get the care they need and to help providers improve
medical practice. Barack Obama and Joe Biden will expand and support these and other efforts to lower costs
and improve health outcomes.
HELP PATIENTS
Support disease management programs. Over seventy-five percent of total health care dollars are
spent on patients with one or more chronic conditions, such as diabetes, heart disease, and high blood
pressure.15 Many patients with chronic diseases benefit greatly from disease management programs,
which help patients manage their condition and get the care they need.16 Barack Obama and Joe Biden
will require that plans that participate in the new public plan, Medicare or the Federal Employee Health
Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of
care and lower costs, as well.
LOWER COSTS TO MAKE OUR HEALTH CARE SYSTEM
WORK FOR PEOPLE AND BUSINESSES – NOT JUST
INSURANCE COMPANIES
Coordinate and integrate care. Rates of chronic diseases have skyrocketed in the last 2 decades.17
Over 133 million Americans have at least one chronic disease.18 With proper care, the onset and
progression of these diseases can be contained for many years. In addition to the needless suffering and
early death they cause, these chronic conditions cost a staggering $1.7 trillion yearly.19 Barack Obama
and Joe Biden will support providers to put in place care management programs and encourage team
care through implementation of medical home type models that will improve coordination and
integration of care of those with chronic conditions.
Require full transparency regarding quality and costs. Health care quality and costs can vary
tremendously among hospitals and providers; however, patients have limited access to this
information.20 Barack Obama and Joe Biden will require hospitals and providers to collect and publicly
report measures of health care costs and quality, including data on preventable medical errors, nurse
staffing ratios, hospital-acquired infections, and disparities in care and costs. Health plans will be
required to disclose the percentage of premiums that actually goes to paying for patient care as opposed
to administrative costs.
ENSURE PROVIDERS DELIVER QUALITY CARE
Promote patient safety. Barack Obama and Joe Biden will require providers to report preventable
medical errors, and support hospital and physician practice improvement to prevent future errors.
Align incentives for excellence. Both public and private insurers tend to pay providers based on the
volume of services provided, rather than the quality or effectiveness of care.21 Barack Obama and Joe
Biden will accelerate efforts to develop and disseminate best practices, and align reimbursement with
provision of high quality health care. Providers who see patients enrolled in the new public plan, the
National Health Insurance Exchange, Medicare and FEHB will be rewarded for achieving performance
thresholds on physician-validated outcome measures.
Comparative effectiveness reviews and research. One of the keys to eliminating waste and missed
opportunities is to increase our investment in comparative effectiveness reviews and research. This
information is developed by reviewing existing literature, analyzing electronic health care data, and
conducting simple, real world studies of new technologies. Barack Obama and Joe Biden will establish
an independent institute to guide reviews and research on comparative effectiveness, so that Americans
and their doctors will have accurate and objective information to make the best decisions for their health
and well-being.
Tackle disparities in health care. Although all Americans are affected by problems with our health
care delivery system, an overwhelming body of evidence demonstrates that certain populations are
significantly more likely to receive lower quality health care than others. Barack Obama and Joe Biden
will tackle the root causes of health disparities by addressing differences in access to health coverage
and promoting prevention and public health, both of which play a major role in addressing disparities.
They will also challenge the medical system to eliminate inequities in health care by requiring hospitals
and health plans to collect, analyze and report health care quality for disparity populations and holding
them accountable for any differences found; diversifying the workforce to ensure culturally effective
care; implementing and funding evidence-based interventions, such as patient navigator programs; and
supporting and expanding the capacity of safety-net institutions, which provide a disproportionate
amount of care for underserved populations with inadequate funding and technical resources.
Reform medical malpractice while preserving patient rights. Increasing medical malpractice
insurance rates are making it harder for doctors to practice medicine22 and raising the costs of health
care for everyone.23 Barack Obama and Joe Biden will strengthen antitrust laws to prevent insurers
from overcharging physicians for their malpractice insurance. Barack Obama and Joe Biden will also
promote new models for addressing physician errors that improve patient safety, strengthen the doctorpatient
relationship, and reduce the need for malpractice suits.
(3) LOWER COSTS BY TAKING ON ANTICOMPETITIVE ACTIONS IN THE DRUG AND INSURANCE COMPANIES. It
is not right that Americans families are paying skyrocketing premiums while drug and insurance industries are
enjoying record profits. These companies benefit most from the status quo and in many cases are the greatest
obstacles to reform. The Obama-Biden plan will tackle needless waste and spiraling costs by increasing
competition in the insurance and drug markets.
Increasing competition in the insurance industry. The insurance business today is dominated by a
small group of large companies that has been gobbling up their rivals. In recent years, for-profit
companies have bought up not-for-profit insurers around the country. There have been over 400 health
care mergers in the last 10 years and just two companies dominate a full third of the national market.24
These changes were supposed to make the industry more efficient, but instead premiums have
skyrocketed, increasing over 87 percent over the past six years.25 Over the same time period, insurance
administrative overhead has been the fastest-growing component of health spending. The 2007
Commonwealth Fund Commission on a High Performance Health System reported that between 2000
and 2005, administrative overhead – including both administrative expenses and insurance industry
profits – increased 12.0 percent per year, 3.4 percentage points faster than the average health
expenditure growth of 8.6 percent.26
And while health care costs continue to rise for families, CEOs of these insurance companies have
received multi-million dollar bonuses.27 Barack Obama and Joe Biden will prevent companies from
abusing their monopoly power through unjustified price increases. In markets where the insurance
business is not competitive, their plan will force insurers to pay out a reasonable share of their premiums
for patient care instead of keeping exorbitant amounts for profits and administration. Barack Obama and
Joe Biden’s new National Health Insurance Exchange will also help increase competition by insurers.
Prevent private insurance waste and abuse in Medicare. Medicare’s private plan alternative, called
Medicare Advantage, was established to increase competition and reduce costs. But independent reports
show that on average the government pays 12 percent more than it costs to treat comparable
beneficiaries through traditional Medicare.28 These excessive subsidies cost the government billions of
dollars every year and create an incentive structure that has led to fraudulent abuses of seniors. Barack
Obama and Joe Biden believe we need to eliminate the excessive subsidies to Medicare Advantage plans
and pay them the same amount it would cost to treat the same patients under regular Medicare.
Allow consumers to import safe drugs from other countries. The second-fastest growing type of
health expenses is prescription drugs.29 Pharmaceutical companies should profit when their research and
development results in a groundbreaking new drug. But some companies are exploiting Americans by
dramatically overcharging U.S. consumers. These companies are selling the exact same drugs in Europe
and Canada but charging Americans a 67 percent premium.30 Barack Obama and Joe Biden will allow
Americans to buy their medicines from other developed countries if the drugs are safe and prices are
lower outside the U.S.
Prevent drug companies from blocking generic drugs from consumers. Some drug manufacturers
are explicitly paying generic drug makers not to enter the market so they can preserve their monopolies
and keep charging Americans exorbitant prices for brand name products.31 The Obama-Biden plan will
work to ensure that market power does not lead to higher prices for consumers. Their plan will work to
increase use of generic drugs in the new public plan, Medicare, Medicaid, FEHBP and prohibit large
drug companies from keeping generics out of markets.
Allow Medicare to negotiate for cheaper drug prices. The 2003 Medicare Prescription Drug
Improvement and Modernization Act bans the government from negotiating down the prices of
prescription drugs, even though the Department of Veterans Affairs’ negotiation of prescription drug
prices with drug companies has garnered significant savings for taxpayers.32 Barack Obama and Joe
Biden will repeal the ban on direct negotiation with drug companies and use the resulting savings, which
could be as high as $30 billion,33 to further invest in improving health care coverage and quality.
(4) REDUCE COSTS OF CATASTROPHIC ILLNESSES FOR EMPLOYERS AND THEIR EMPLOYEES. Catastrophic
health expenditures account for a high percentage of medical expenses for private insurers.34 In fact, the most
recent data available reveals that the top five percent of people with the greatest health care expenses in the U.S.
account for 49 percent of the overall health care dollar.35 For small businesses, having a single employee with
catastrophic expenditures can make insurance unaffordable to all of the workers in the firm. The Obama-Biden
plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold
if they guarantee such savings are used to reduce the cost of workers' premiums. Offsetting some of the
catastrophic costs would make health care more affordable for employers, workers and their families.
Barack Obama and Joe Biden will guarantee affordable, accessible health care coverage for all Americans.
Currently, there are over 45 million Americans lacking health insurance, and millions more are at risk of losing
their coverage due to rising costs.36 Rising costs are also a burden on employers, particularly small businesses,
which are increasingly unable to provide health insurance coverage for their employees and remain competitive.
Nearly two million fewer Americans receive health insurance coverage through their employers now compared
to eight years ago,37 and this trend shows no sign of slowing down. It is simply too expensive for individuals
and families to buy insurance directly on the open market and impossible for many with pre-existing conditions.
The Obama-Biden plan both builds on and improves our current insurance system, which most Americans
continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under the Obama-Biden
plan, Americans will be able to maintain their current coverage, have access to new affordable options, and see
the quality of their health care improve and their costs go down. The Obama-Biden plan provides new
affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a
National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3)
providing new tax credits to families who can’t afford health insurance and to small businesses with a new
Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for
their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5)
expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform
plans.
(1) GUARANTEED ELIGIBILITY. Obama and Biden will require insurance companies to cover pre-existing
conditions so all Americans, regardless of their health status or history, can get comprehensive benefits at fair
and stable premiums.
(2) NEW AFFORDABLE, ACCESSIBLE HEALTH INSURANCE OPTIONS. The Obama-Biden plan will create a
National Health Insurance Exchange to help individuals purchase new affordable health care options if they are
uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to
enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be
AFFORDABLE, ACCESSIBLE COVERAGE OPTIONS FOR ALL
provided for people and families who need it. Insurers would have to issue every applicant a policy and charge
fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans
offered are at least as generous as the new public plan and meet the same standards for quality and efficiency.
Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange
would evaluate plans and make the differences among the plans, including cost of services, transparent.
The Exchange will have the following features:
Comprehensive benefits. The benefit package will be similar to that offered through the Federal
Employees Health Benefits Program (FEHBP), the program through which Members of Congress get
their own health care. Plans will include coverage of all essential medical services, including preventive,
maternity and mental health care.
Affordable premiums, co-pays and deductibles. Participants will be charged fair premiums and
minimal co-pays for deductibles for preventive services.
Simplified paperwork. The plan will simplify paperwork for providers and will increase savings to the
system overall.
Easy enrollment. All Exchange health insurance plans will be simple to enroll in and provide ready
access to coverage.
Portability and choice. Participants will be able to move from job to job without changing or
jeopardizing their health care coverage.
Quality and efficiency. Participating hospitals and providers that participate in the new public plan will
be required to collect and report data to ensure that standards for health care quality, health information
technology and administration are being met.
(3) TAX CREDITS FOR FAMILIES AND SMALL BUSINESSES. Barack Obama and Joe Biden understand that too
many families that do not qualify for public health programs like Medicaid and SCHIP have trouble finding
affordable health insurance. They know from talking to small business owners across the nation that the
skyrocketing cost of healthcare poses a serious competitive threat to America’s small businesses. The Obama-
Biden health care plan will provide tax credits to all individuals who need it for their premiums. They will also
create a new Small Business Health Tax Credit to provide small businesses with a refundable tax credit of up to
50 percent on premiums paid by small businesses on behalf of their employees. To be eligible for the credit,
small businesses will have to offer a quality health plan to all of their employees and cover a meaningful share
of the cost of employee health premiums.
(4) EMPLOYER CONTRIBUTION. Large employers that do not offer meaningful coverage or make a meaningful
contribution to the cost of quality health coverage for their employees will be required to contribute a
percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this
requirement.
(5) REQUIRE COVERAGE OF CHILDREN. Barack Obama and Joe Biden will require that all children have health
care coverage. Barack Obama and Joe Biden will expand the number of options for young adults to get
coverage by allowing young people up to age 25 to continue coverage through their parents’ plans.
(6) EXPANSION OF MEDICAID AND SCHIP. Barack Obama and Joe Biden will expand eligibility for the
Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net
function.
(7) FLEXIBILITY FOR STATE PLANS. Due to federal inaction, some states have taken the lead in health care
reform. Under the Obama-Biden plan, states can continue to experiment, provided they meet the minimum
standards of the national plan.
Covering the uninsured and modernizing America’s health care system are urgent priorities, but they are not
enough. This nation is facing a true epidemic of chronic disease. An increasing number of Americans are
suffering and dying needlessly from diseases such as obesity, diabetes, heart disease, asthma and HIV/AIDS, all
of which can be delayed in onset if not prevented entirely. One in 3 Americans—133 million—have a chronic
condition, and children are increasingly being affected.38 Five chronic diseases—heart disease, cancer, stroke,
chronic obstructive pulmonary disease, and diabetes—cause over two-thirds of all deaths each year.39
In addition to the tremendous human cost, chronic diseases exact a tremendous financial toll on our health care
resources. Care for patients with diabetes costs $130 billion each year alone, and this amount is growing.40
Tackling chronic diseases is also straining our public health departments and finances, which are already
stretched too thin carrying out traditional public health functions, which include ensuring our water is safe to
drink, the air is safe to breathe, and our food is safe to eat.
Barack Obama and Joe Biden believe that protecting and promoting health and wellness in this nation is a
shared responsibility among individuals and families, school systems, employers, the medical and public health
workforce, and federal and state and local governments. All parties must do their part, as well as collaborate
with one another, to create the conditions and opportunities that will allow and encourage Americans to adopt
healthy lifestyles.
(1) EMPLOYERS. Reduced workforce productivity from illness and disability represents an additional drain on
business. To address employee health, an increasing number of employers are offering worksite health
promotion programs, onsite clinical preventive services such as flu vaccinations, nutritious foods in cafeterias
and vending machines, and exercise facilities. Equally important, many employers choose insurance plans that
cover preventive services for their employees. Barack Obama and Joe Biden believe that worksite interventions
hold tremendous potential to influence health and they will expand and reward these efforts.
(2) SCHOOL SYSTEMS. Childhood obesity is nearly epidemic,41 particularly among minority populations,42 and
school systems can play an important role in tackling this issue. For example, only about a quarter of schools
adhere to nutritional standards for fat content in school lunches.43 Barack Obama and Joe Biden will work with
schools to create more healthful environments for children, including assistance with contract policy
development for local vendors, grant support for school-based health screening programs and clinical services,
increased financial support for physical education, and educational programs for students.
(3) WORKFORCE. Primary care providers and public health practitioners have and will continue to lead efforts
to protect and promote the nation’s health. Yet, the numbers of both are dwindling,44 and the existing
workforce is further challenged by inadequate training for new health threats such as bioterrorism and avian flu,
antiquated funding and reimbursement mechanisms, and limited access to real-time information and technical
support. Barack Obama and Joe Biden will expand funding—including loan repayment, adequate
reimbursement, grants for training curricula, and infrastructure support to improve working conditions— to
ensure a strong workforce that will champion prevention and public health activities.
PROMOTING PREVENTION & STRENGTHENING
PUBLIC HEALTH
(4) INDIVIDUALS AND FAMILIES. Preventive care only works if Americans take personal responsibility for their
health and make the right decisions in their own lives – if they eat the right foods, stay active, and stop smoking.
Barack Obama and Joe Biden will ensure that all Americans are empowered to monitor their health by ensuring
coverage of essential clinical services in all federally supported health plans, including Medicare, Medicaid,
SCHIP and the new public plan. Americans also benefit from healthy environments that allow them to pursue
healthy choices and behaviors that can help ward off chronic and preventable diseases. Healthy environments
include sidewalks, biking paths and walking trails; local grocery stores with fruits and vegetables; restricted
advertising for tobacco and alcohol to children; and wellness and educational campaigns. In addition, Barack
Obama and Joe Biden will increase funding to expand community based preventive interventions to help
Americans make better choices to improve their health.
(5) FEDERAL, STATE, AND LOCAL GOVERNMENTS. The federal government and state and local governments
play critical roles across the full range of disease prevention and health promotion activities. First, working
together, governments at all levels should lead the effort to develop a national and regional strategy for public
health and align funding mechanisms to support its implementation. Second, the field of public health would
benefit from greater research to optimize organization of the 3,000 health departments in this nation,45
collaborative arrangements between levels of government and its private partners, performance and
accountability indicators, integrated and interoperable communication networks, and disaster preparedness and
response. Third, the government must invest in workforce recruitment as well as modernizing our physical
structures, particularly our public health laboratories. And finally, the government must examine its own
policies, including agricultural, educational, environmental and health policies, to assess and improve their
effect on public health in this nation. Barack Obama and Joe Biden will prioritize all of these activities, to
ensure a 21st century public health system and healthy America.
Paid for by Obama for America
Printed in House
1 Kaiser Family Foundation and Health Research and Educational Trust. (2008). Employer Health Benefits 2008,
http://kff.org/insurance/7527/index.cfm; Bureau of Labor Statistics, Sept. 2008
2 David U. Himmelstein, Elizabeth Warren, Deborah Thorne, and Steffie Wooldhandler (February 2005). “Illness and Injury as
Contributors to Bankruptcy,” Health Affairs, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.63v1
3 Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors; Committee on Quality of Health Care in America, Institute of
Medicine (2000). To Err is Human. Washington, DC: National Academy Press.
4 Steffie Woolhandler, Terry Campbell, and David U. Himmelstein (2003) “Costs of Health Care Administration in the United States
and Canada.” New England Journal of Medicine.
5 Census Bureau, August 2008, http://www.census.gov/prod/2008pubs/p60-235.pdf
6 Id.
7 Kaiser Family Foundation, The Uninsured: A Primer (2006), http://kff.org/uninsured/upload/7451-021.pdf
8 Jeanne M. Lambrew, (April 2007). A Wellness Trust to Prioritize Disease Prevention. The Hamilton Project, Brookings Institution.
http://www3.brookings.edu/views/papers/200704lambrew.pdf
9 Commonwealth Fund, Why Not the Best? Results from a National Scorecard on U.S. Health Systems Performance, September 2006,
http://www.cmwf.org/publications/publications_show.htm?doc_id=401577
10 Steffie Woolhandler, Terry Campbell, and David U. Himmelstein (2003) “Costs of Health Care Administration in the United States
and Canada.” New England Journal of Medicine.
11 Office of the Actuary. (February 2007). National Health Expenditures
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2006.pdf
12 Dartmouth Atlas Project (2006), The Care of Patients with Severe Chronic Illness,
http://www.dartmouthatlas.org/atlases/2006_Chronic_Care_Atlas.pdf
13 Federico Girosi, Robin Meili, and Richard Scoville (2005), Extrapolating Evidence of Health Information Technology Savings and
Costs. RAND, page 79.
14 Federico Girosi, Robin Meili, and Richard Scoville (2005), Extrapolating Evidence of Health Information Technology Savings and
Costs. RAND, page 36.
15 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia JohnsonChronic Conditions: Making the Case for Ongoing Care
(2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
16 Center on an Aging Society at Georgetown Univeristy, Disease Management Programs: Improving Health and while Reducing
Costs?, p4, (January 2004). http://hpi.georgetown.edu/agingsociety/pdfs/management.pdf
17 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia JohnsonChronic Conditions: Making the Case for Ongoing Care
(2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
18 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia JohnsonChronic Conditions: Making the Case for Ongoing Care
(2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
19 CMS. (February 2007). National Health Expenditures; Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia
JohnsonChronic Conditions: Making the Case for Ongoing Care (2004). Partnership for Solutions (Johns Hopkins and Robert Wood
Johnson Foundation).
20 National Committee for Quality Assurance (2006), The State of Health Care 2006,
http://www.ncqa.org/communications/sohc2006/sohc_2006.pdf
21 Jeanne M. Lambrew, (April 2007). A Wellness Trust to Prioritize Disease Prevention. The Hamilton Project, Brookings Institution.
http://www3.brookings.edu/views/papers/200704lambrew.pdf
22 Kenneth Thorpe (January 21, 2004), The Medical Malpractice ‘Crisis’: Recent Trends and the Impact of State Tort Claims, Health
Affairs, http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.20v1/DC1#39
23 Department of Health and Human Services (March 3, 2003), Addressing the New Health Care Crisis: Reforming the Medical
Litigation System to Improve the Quality of Care, http://aspe.hhs.gov/daltcp/reports/medliab.htm
24 Edward Langston, “Statement of the American Medical Association to the Senate Committee on the Judicary, United States Senate”
(September 6, 2006). Testimony.
25 Kaiser Family Foundation and Health Research and Educational Trust. (2006). Employer Health Benefits 2006,
http://kff.org/insurance/7527/index.cfm
26 Karen Davis, Cathy Schoen, Stuart Guterman et al. (January 2007), Slowing the Growth of U.S. Health Care Expenditures: What
are the Options? Commonwealth Fund
27 Forbes.com, 2007 CEO Executive Compensation – Health Care Equipment & Services,
http://www.forbes.com/lists/2007/12/lead_07ceos_CEO-Compensation-Health-care-equipment-services_9Rank.html
28 Glenn Hackbarth, Medicare Payment Advisory Commission (April 11, 2007), Testimony: The Medicare Advantage Program and
MedPAC Recommendations, U.S. Senate Committee on Finance,
http://www.medpac.gov/publications/congressional_testimony/041107_Finance_testimony_MA.pdf?CFID=6602154&CFTOKEN=81
609996
29 Karen Davis, Cathy Schoen, Stuart Guterman et al. (January 2007), Slowing the Growth of U.S. Health Care Expenditures: What
are the Options? Commonwealth Fund.
30 Patented Medicine Prices Review Board, Annual Report (Ottawa, Ontario: PMPRB, 2002), p. 23.
31 Marc Kaufman (April 25, 2006), “Drug Firms’ Deals with Allowing Exclusivity,” Washington Post,
http://www.washingtonpost.com/wp-dyn/content/article/2006/04/24/AR2006042401508.html
32 Families USA (December 2005), Falling Short: Medicare Prescription Drug Plans Offer Meager Savings,
http://www.familiesusa.org/assets/pdfs/PDP-vs-VA-prices-special-report.pdf
33 Roger Hickey & Jeff Cruz (April 2007), Waste and Inefficiency in the Bush Medicare Prescription Drug Plan: Allowing Medicare
to Negotiate Lower Prices Could Save $30 Billion a Year, Institute for America’s Future,
http://cdncon.vo.llnwd.net/o2/fotf/medicare/National_Savings.pdf
34 Mark W. Stanton and Margaret Rutherford (June 2006), The High Concentration of U.S. Health Care Expenditures. Agency for
Healthcare Research and Quality. Research in Action Issue 19.
35 Mark W. Stanton and Margaret Rutherford (June 2006), The High Concentration of U.S. Health Care Expenditures. Agency for
Healthcare Research and Quality. Research in Action Issue 19.
36 Census Bureau, “Census Bureau Revises 2004 and 2005 Health Insurance Coverage Estimates,” March 23, 2007.
http://www.census.gov/Press-Release/www/releases/archives/health_care_insurance/009789.html
37 Census Bureau (2008), Income, Poverty, and Health Insurance Coverage in the United States: 2007. Table C-1.
38 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia JohnsonChronic Conditions: Making the Case for Ongoing Care
(2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
39 CDC, http://www.cdc.gov/nccdphp/overview.htm
40 CDC, http://www.cdc.gov/nccdphp/press/index.htm
41 NIH, Childhood Obesity, June 2002 Word on Health http://www.nih.gov/news/WordonHealth/jun2002/childhoodobesity.htm
42 CDC National Center for Health Statistics, http://www.cdc.gov/nchs/pressroom/06facts/obesity03_04.htm
43 GAO (2003), School Lunch Program: Efforts Needed to Improve Nutrition and Encourage Healthy Eating,
http://www.gao.gov/new.items/d03506.pdf
44 The Robert Graham Center (October 2003), http://www.graham-center.org/x468.xml; Institute of Medicine (2002), The Future of
the Public’s Health in the 21st Century, p.364.
45 Bob Prentice and George Flores (December 15, 2006), Local Health Departments and the Challenge of Chronic Disease: Lessons
From California, NIH, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1832141
AND ENSURE AFFORDABLE, ACCESSIBLE HEALTH COVERAGE FOR ALL
Health care costs are skyrocketing. Health insurance premiums have doubled in the last 8 years, rising 3.7
times faster than wages in the past 8 years, and increasing co-pays and deductibles threaten access to care.1
Many insurance plans cover only a limited number of doctors’ visits or hospital days, exposing families to
unlimited financial liability. Over half of all personal bankruptcies today are caused by medical bills.2 Lack of
affordable health care is compounded by serious flaws in our health care delivery system. About 100,000
Americans die from medical errors in hospitals every year.3 One-quarter of all medical spending goes to
administrative and overhead costs, and reliance on antiquated paper-based record and information systems
needlessly increases these costs.4
Tens of millions of Americans are uninsured because of rising costs. Over 45 million Americans5—
including over 8 million children6—lack health insurance. Eighty percent of the uninsured are in working
families.7 Even those with health coverage are struggling to cope with soaring medical costs. Skyrocketing
health care costs are making it increasingly difficult for employers, particularly small businesses, to provide
health insurance to their employees.
Underinvestment in prevention and public health. Too many Americans go without high-value preventive
services, such as cancer screening and immunizations to protect against flu or pneumonia. The nation faces
epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Yet despite
all of this less than 4 cents of every health care dollar is spent on prevention and public health.8 Our health care
system has become a disease care system, and the time for change is well overdue.
OBAMA-BIDEN PLAN TO PROVIDE AFFORDABLE, ACCESSIBLE HEALTH CARE TO ALL
Barack Obama and Joe Biden’s plan strengthens employer–based coverage, makes insurance companies
accountable and ensures patient choice of doctor and care without government interference. Under the plan, if
you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500
per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance
options.
Inefficient and poor quality care costs the nation at least $50 to $100 billion every year.9 Billions more are
wasted on administration and overhead because of inefficiencies in the health care system.10 And given current
trends, this problem will only get worse as health care spending is expected to double within the next decade.11
A growing body of research points to substantial opportunities to improve quality while reducing the costs of
care. Health care systems in many parts of the country deliver high quality care to the populations they serve at
half the cost of other equally renowned academic medical centers in other parts of the country.12 The key is to
provide information, incentives and support to help physicians and others work together to improve quality of
care while reducing costs.
Barack Obama and Joe Biden believe we must redesign our health system to reduce inefficiency and waste and
improve health care quality, which will drive down costs for families and individuals. The Obama-Biden plan
will improve efficiency and lower costs in the health care system by: (1) adopting state-of-the-art health
information technology systems; (2) ensuring that patients receive and providers deliver the best possible care,
including prevention and chronic disease management services; (3) reforming our market structure to increase
competition; and offering federal reinsurance to employers to help ensure that unexpected or catastrophic
illnesses do not make health insurance unaffordable or out of reach for businesses and their employees.
(1) INVEST IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS. Most medical records are still
stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors.
Processing paper claims also costs twice as much as processing electronic claims.13 Barack Obama and Joe
Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad
adoption of standards-based electronic health information systems, including electronic health records. They
will also phase in requirements for full implementation of health IT and commit the necessary federal resources
to make it happen. Barack Obama and Joe Biden will ensure that these systems are developed in coordination
with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe
Biden will ensure that patients’ privacy is protected. A study by the Rand Corporation found that if most
hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized
each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary
testing, more appropriate drug utilization, and other efficiencies.14
(2) IMPROVE ACCESS TO PREVENTION AND PROVEN DISEASE MANAGEMENT PROGRAMS. Experts agree that
several steps should be taken immediately to help patients get the care they need and to help providers improve
medical practice. Barack Obama and Joe Biden will expand and support these and other efforts to lower costs
and improve health outcomes.
HELP PATIENTS
Support disease management programs. Over seventy-five percent of total health care dollars are
spent on patients with one or more chronic conditions, such as diabetes, heart disease, and high blood
pressure.15 Many patients with chronic diseases benefit greatly from disease management programs,
which help patients manage their condition and get the care they need.16 Barack Obama and Joe Biden
will require that plans that participate in the new public plan, Medicare or the Federal Employee Health
Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of
care and lower costs, as well.
LOWER COSTS TO MAKE OUR HEALTH CARE SYSTEM
WORK FOR PEOPLE AND BUSINESSES – NOT JUST
INSURANCE COMPANIES
Coordinate and integrate care. Rates of chronic diseases have skyrocketed in the last 2 decades.17
Over 133 million Americans have at least one chronic disease.18 With proper care, the onset and
progression of these diseases can be contained for many years. In addition to the needless suffering and
early death they cause, these chronic conditions cost a staggering $1.7 trillion yearly.19 Barack Obama
and Joe Biden will support providers to put in place care management programs and encourage team
care through implementation of medical home type models that will improve coordination and
integration of care of those with chronic conditions.
Require full transparency regarding quality and costs. Health care quality and costs can vary
tremendously among hospitals and providers; however, patients have limited access to this
information.20 Barack Obama and Joe Biden will require hospitals and providers to collect and publicly
report measures of health care costs and quality, including data on preventable medical errors, nurse
staffing ratios, hospital-acquired infections, and disparities in care and costs. Health plans will be
required to disclose the percentage of premiums that actually goes to paying for patient care as opposed
to administrative costs.
ENSURE PROVIDERS DELIVER QUALITY CARE
Promote patient safety. Barack Obama and Joe Biden will require providers to report preventable
medical errors, and support hospital and physician practice improvement to prevent future errors.
Align incentives for excellence. Both public and private insurers tend to pay providers based on the
volume of services provided, rather than the quality or effectiveness of care.21 Barack Obama and Joe
Biden will accelerate efforts to develop and disseminate best practices, and align reimbursement with
provision of high quality health care. Providers who see patients enrolled in the new public plan, the
National Health Insurance Exchange, Medicare and FEHB will be rewarded for achieving performance
thresholds on physician-validated outcome measures.
Comparative effectiveness reviews and research. One of the keys to eliminating waste and missed
opportunities is to increase our investment in comparative effectiveness reviews and research. This
information is developed by reviewing existing literature, analyzing electronic health care data, and
conducting simple, real world studies of new technologies. Barack Obama and Joe Biden will establish
an independent institute to guide reviews and research on comparative effectiveness, so that Americans
and their doctors will have accurate and objective information to make the best decisions for their health
and well-being.
Tackle disparities in health care. Although all Americans are affected by problems with our health
care delivery system, an overwhelming body of evidence demonstrates that certain populations are
significantly more likely to receive lower quality health care than others. Barack Obama and Joe Biden
will tackle the root causes of health disparities by addressing differences in access to health coverage
and promoting prevention and public health, both of which play a major role in addressing disparities.
They will also challenge the medical system to eliminate inequities in health care by requiring hospitals
and health plans to collect, analyze and report health care quality for disparity populations and holding
them accountable for any differences found; diversifying the workforce to ensure culturally effective
care; implementing and funding evidence-based interventions, such as patient navigator programs; and
supporting and expanding the capacity of safety-net institutions, which provide a disproportionate
amount of care for underserved populations with inadequate funding and technical resources.
Reform medical malpractice while preserving patient rights. Increasing medical malpractice
insurance rates are making it harder for doctors to practice medicine22 and raising the costs of health
care for everyone.23 Barack Obama and Joe Biden will strengthen antitrust laws to prevent insurers
from overcharging physicians for their malpractice insurance. Barack Obama and Joe Biden will also
promote new models for addressing physician errors that improve patient safety, strengthen the doctorpatient
relationship, and reduce the need for malpractice suits.
(3) LOWER COSTS BY TAKING ON ANTICOMPETITIVE ACTIONS IN THE DRUG AND INSURANCE COMPANIES. It
is not right that Americans families are paying skyrocketing premiums while drug and insurance industries are
enjoying record profits. These companies benefit most from the status quo and in many cases are the greatest
obstacles to reform. The Obama-Biden plan will tackle needless waste and spiraling costs by increasing
competition in the insurance and drug markets.
Increasing competition in the insurance industry. The insurance business today is dominated by a
small group of large companies that has been gobbling up their rivals. In recent years, for-profit
companies have bought up not-for-profit insurers around the country. There have been over 400 health
care mergers in the last 10 years and just two companies dominate a full third of the national market.24
These changes were supposed to make the industry more efficient, but instead premiums have
skyrocketed, increasing over 87 percent over the past six years.25 Over the same time period, insurance
administrative overhead has been the fastest-growing component of health spending. The 2007
Commonwealth Fund Commission on a High Performance Health System reported that between 2000
and 2005, administrative overhead – including both administrative expenses and insurance industry
profits – increased 12.0 percent per year, 3.4 percentage points faster than the average health
expenditure growth of 8.6 percent.26
And while health care costs continue to rise for families, CEOs of these insurance companies have
received multi-million dollar bonuses.27 Barack Obama and Joe Biden will prevent companies from
abusing their monopoly power through unjustified price increases. In markets where the insurance
business is not competitive, their plan will force insurers to pay out a reasonable share of their premiums
for patient care instead of keeping exorbitant amounts for profits and administration. Barack Obama and
Joe Biden’s new National Health Insurance Exchange will also help increase competition by insurers.
Prevent private insurance waste and abuse in Medicare. Medicare’s private plan alternative, called
Medicare Advantage, was established to increase competition and reduce costs. But independent reports
show that on average the government pays 12 percent more than it costs to treat comparable
beneficiaries through traditional Medicare.28 These excessive subsidies cost the government billions of
dollars every year and create an incentive structure that has led to fraudulent abuses of seniors. Barack
Obama and Joe Biden believe we need to eliminate the excessive subsidies to Medicare Advantage plans
and pay them the same amount it would cost to treat the same patients under regular Medicare.
Allow consumers to import safe drugs from other countries. The second-fastest growing type of
health expenses is prescription drugs.29 Pharmaceutical companies should profit when their research and
development results in a groundbreaking new drug. But some companies are exploiting Americans by
dramatically overcharging U.S. consumers. These companies are selling the exact same drugs in Europe
and Canada but charging Americans a 67 percent premium.30 Barack Obama and Joe Biden will allow
Americans to buy their medicines from other developed countries if the drugs are safe and prices are
lower outside the U.S.
Prevent drug companies from blocking generic drugs from consumers. Some drug manufacturers
are explicitly paying generic drug makers not to enter the market so they can preserve their monopolies
and keep charging Americans exorbitant prices for brand name products.31 The Obama-Biden plan will
work to ensure that market power does not lead to higher prices for consumers. Their plan will work to
increase use of generic drugs in the new public plan, Medicare, Medicaid, FEHBP and prohibit large
drug companies from keeping generics out of markets.
Allow Medicare to negotiate for cheaper drug prices. The 2003 Medicare Prescription Drug
Improvement and Modernization Act bans the government from negotiating down the prices of
prescription drugs, even though the Department of Veterans Affairs’ negotiation of prescription drug
prices with drug companies has garnered significant savings for taxpayers.32 Barack Obama and Joe
Biden will repeal the ban on direct negotiation with drug companies and use the resulting savings, which
could be as high as $30 billion,33 to further invest in improving health care coverage and quality.
(4) REDUCE COSTS OF CATASTROPHIC ILLNESSES FOR EMPLOYERS AND THEIR EMPLOYEES. Catastrophic
health expenditures account for a high percentage of medical expenses for private insurers.34 In fact, the most
recent data available reveals that the top five percent of people with the greatest health care expenses in the U.S.
account for 49 percent of the overall health care dollar.35 For small businesses, having a single employee with
catastrophic expenditures can make insurance unaffordable to all of the workers in the firm. The Obama-Biden
plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold
if they guarantee such savings are used to reduce the cost of workers' premiums. Offsetting some of the
catastrophic costs would make health care more affordable for employers, workers and their families.
Barack Obama and Joe Biden will guarantee affordable, accessible health care coverage for all Americans.
Currently, there are over 45 million Americans lacking health insurance, and millions more are at risk of losing
their coverage due to rising costs.36 Rising costs are also a burden on employers, particularly small businesses,
which are increasingly unable to provide health insurance coverage for their employees and remain competitive.
Nearly two million fewer Americans receive health insurance coverage through their employers now compared
to eight years ago,37 and this trend shows no sign of slowing down. It is simply too expensive for individuals
and families to buy insurance directly on the open market and impossible for many with pre-existing conditions.
The Obama-Biden plan both builds on and improves our current insurance system, which most Americans
continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under the Obama-Biden
plan, Americans will be able to maintain their current coverage, have access to new affordable options, and see
the quality of their health care improve and their costs go down. The Obama-Biden plan provides new
affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a
National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3)
providing new tax credits to families who can’t afford health insurance and to small businesses with a new
Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for
their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5)
expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform
plans.
(1) GUARANTEED ELIGIBILITY. Obama and Biden will require insurance companies to cover pre-existing
conditions so all Americans, regardless of their health status or history, can get comprehensive benefits at fair
and stable premiums.
(2) NEW AFFORDABLE, ACCESSIBLE HEALTH INSURANCE OPTIONS. The Obama-Biden plan will create a
National Health Insurance Exchange to help individuals purchase new affordable health care options if they are
uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to
enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be
AFFORDABLE, ACCESSIBLE COVERAGE OPTIONS FOR ALL
provided for people and families who need it. Insurers would have to issue every applicant a policy and charge
fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans
offered are at least as generous as the new public plan and meet the same standards for quality and efficiency.
Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange
would evaluate plans and make the differences among the plans, including cost of services, transparent.
The Exchange will have the following features:
Comprehensive benefits. The benefit package will be similar to that offered through the Federal
Employees Health Benefits Program (FEHBP), the program through which Members of Congress get
their own health care. Plans will include coverage of all essential medical services, including preventive,
maternity and mental health care.
Affordable premiums, co-pays and deductibles. Participants will be charged fair premiums and
minimal co-pays for deductibles for preventive services.
Simplified paperwork. The plan will simplify paperwork for providers and will increase savings to the
system overall.
Easy enrollment. All Exchange health insurance plans will be simple to enroll in and provide ready
access to coverage.
Portability and choice. Participants will be able to move from job to job without changing or
jeopardizing their health care coverage.
Quality and efficiency. Participating hospitals and providers that participate in the new public plan will
be required to collect and report data to ensure that standards for health care quality, health information
technology and administration are being met.
(3) TAX CREDITS FOR FAMILIES AND SMALL BUSINESSES. Barack Obama and Joe Biden understand that too
many families that do not qualify for public health programs like Medicaid and SCHIP have trouble finding
affordable health insurance. They know from talking to small business owners across the nation that the
skyrocketing cost of healthcare poses a serious competitive threat to America’s small businesses. The Obama-
Biden health care plan will provide tax credits to all individuals who need it for their premiums. They will also
create a new Small Business Health Tax Credit to provide small businesses with a refundable tax credit of up to
50 percent on premiums paid by small businesses on behalf of their employees. To be eligible for the credit,
small businesses will have to offer a quality health plan to all of their employees and cover a meaningful share
of the cost of employee health premiums.
(4) EMPLOYER CONTRIBUTION. Large employers that do not offer meaningful coverage or make a meaningful
contribution to the cost of quality health coverage for their employees will be required to contribute a
percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this
requirement.
(5) REQUIRE COVERAGE OF CHILDREN. Barack Obama and Joe Biden will require that all children have health
care coverage. Barack Obama and Joe Biden will expand the number of options for young adults to get
coverage by allowing young people up to age 25 to continue coverage through their parents’ plans.
(6) EXPANSION OF MEDICAID AND SCHIP. Barack Obama and Joe Biden will expand eligibility for the
Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net
function.
(7) FLEXIBILITY FOR STATE PLANS. Due to federal inaction, some states have taken the lead in health care
reform. Under the Obama-Biden plan, states can continue to experiment, provided they meet the minimum
standards of the national plan.
Covering the uninsured and modernizing America’s health care system are urgent priorities, but they are not
enough. This nation is facing a true epidemic of chronic disease. An increasing number of Americans are
suffering and dying needlessly from diseases such as obesity, diabetes, heart disease, asthma and HIV/AIDS, all
of which can be delayed in onset if not prevented entirely. One in 3 Americans—133 million—have a chronic
condition, and children are increasingly being affected.38 Five chronic diseases—heart disease, cancer, stroke,
chronic obstructive pulmonary disease, and diabetes—cause over two-thirds of all deaths each year.39
In addition to the tremendous human cost, chronic diseases exact a tremendous financial toll on our health care
resources. Care for patients with diabetes costs $130 billion each year alone, and this amount is growing.40
Tackling chronic diseases is also straining our public health departments and finances, which are already
stretched too thin carrying out traditional public health functions, which include ensuring our water is safe to
drink, the air is safe to breathe, and our food is safe to eat.
Barack Obama and Joe Biden believe that protecting and promoting health and wellness in this nation is a
shared responsibility among individuals and families, school systems, employers, the medical and public health
workforce, and federal and state and local governments. All parties must do their part, as well as collaborate
with one another, to create the conditions and opportunities that will allow and encourage Americans to adopt
healthy lifestyles.
(1) EMPLOYERS. Reduced workforce productivity from illness and disability represents an additional drain on
business. To address employee health, an increasing number of employers are offering worksite health
promotion programs, onsite clinical preventive services such as flu vaccinations, nutritious foods in cafeterias
and vending machines, and exercise facilities. Equally important, many employers choose insurance plans that
cover preventive services for their employees. Barack Obama and Joe Biden believe that worksite interventions
hold tremendous potential to influence health and they will expand and reward these efforts.
(2) SCHOOL SYSTEMS. Childhood obesity is nearly epidemic,41 particularly among minority populations,42 and
school systems can play an important role in tackling this issue. For example, only about a quarter of schools
adhere to nutritional standards for fat content in school lunches.43 Barack Obama and Joe Biden will work with
schools to create more healthful environments for children, including assistance with contract policy
development for local vendors, grant support for school-based health screening programs and clinical services,
increased financial support for physical education, and educational programs for students.
(3) WORKFORCE. Primary care providers and public health practitioners have and will continue to lead efforts
to protect and promote the nation’s health. Yet, the numbers of both are dwindling,44 and the existing
workforce is further challenged by inadequate training for new health threats such as bioterrorism and avian flu,
antiquated funding and reimbursement mechanisms, and limited access to real-time information and technical
support. Barack Obama and Joe Biden will expand funding—including loan repayment, adequate
reimbursement, grants for training curricula, and infrastructure support to improve working conditions— to
ensure a strong workforce that will champion prevention and public health activities.
PROMOTING PREVENTION & STRENGTHENING
PUBLIC HEALTH
(4) INDIVIDUALS AND FAMILIES. Preventive care only works if Americans take personal responsibility for their
health and make the right decisions in their own lives – if they eat the right foods, stay active, and stop smoking.
Barack Obama and Joe Biden will ensure that all Americans are empowered to monitor their health by ensuring
coverage of essential clinical services in all federally supported health plans, including Medicare, Medicaid,
SCHIP and the new public plan. Americans also benefit from healthy environments that allow them to pursue
healthy choices and behaviors that can help ward off chronic and preventable diseases. Healthy environments
include sidewalks, biking paths and walking trails; local grocery stores with fruits and vegetables; restricted
advertising for tobacco and alcohol to children; and wellness and educational campaigns. In addition, Barack
Obama and Joe Biden will increase funding to expand community based preventive interventions to help
Americans make better choices to improve their health.
(5) FEDERAL, STATE, AND LOCAL GOVERNMENTS. The federal government and state and local governments
play critical roles across the full range of disease prevention and health promotion activities. First, working
together, governments at all levels should lead the effort to develop a national and regional strategy for public
health and align funding mechanisms to support its implementation. Second, the field of public health would
benefit from greater research to optimize organization of the 3,000 health departments in this nation,45
collaborative arrangements between levels of government and its private partners, performance and
accountability indicators, integrated and interoperable communication networks, and disaster preparedness and
response. Third, the government must invest in workforce recruitment as well as modernizing our physical
structures, particularly our public health laboratories. And finally, the government must examine its own
policies, including agricultural, educational, environmental and health policies, to assess and improve their
effect on public health in this nation. Barack Obama and Joe Biden will prioritize all of these activities, to
ensure a 21st century public health system and healthy America.
Paid for by Obama for America
Printed in House
1 Kaiser Family Foundation and Health Research and Educational Trust. (2008). Employer Health Benefits 2008,
http://kff.org/insurance/7527/index.cfm; Bureau of Labor Statistics, Sept. 2008
2 David U. Himmelstein, Elizabeth Warren, Deborah Thorne, and Steffie Wooldhandler (February 2005). “Illness and Injury as
Contributors to Bankruptcy,” Health Affairs, http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.63v1
3 Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors; Committee on Quality of Health Care in America, Institute of
Medicine (2000). To Err is Human. Washington, DC: National Academy Press.
4 Steffie Woolhandler, Terry Campbell, and David U. Himmelstein (2003) “Costs of Health Care Administration in the United States
and Canada.” New England Journal of Medicine.
5 Census Bureau, August 2008, http://www.census.gov/prod/2008pubs/p60-235.pdf
6 Id.
7 Kaiser Family Foundation, The Uninsured: A Primer (2006), http://kff.org/uninsured/upload/7451-021.pdf
8 Jeanne M. Lambrew, (April 2007). A Wellness Trust to Prioritize Disease Prevention. The Hamilton Project, Brookings Institution.
http://www3.brookings.edu/views/papers/200704lambrew.pdf
9 Commonwealth Fund, Why Not the Best? Results from a National Scorecard on U.S. Health Systems Performance, September 2006,
http://www.cmwf.org/publications/publications_show.htm?doc_id=401577
10 Steffie Woolhandler, Terry Campbell, and David U. Himmelstein (2003) “Costs of Health Care Administration in the United States
and Canada.” New England Journal of Medicine.
11 Office of the Actuary. (February 2007). National Health Expenditures
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2006.pdf
12 Dartmouth Atlas Project (2006), The Care of Patients with Severe Chronic Illness,
http://www.dartmouthatlas.org/atlases/2006_Chronic_Care_Atlas.pdf
13 Federico Girosi, Robin Meili, and Richard Scoville (2005), Extrapolating Evidence of Health Information Technology Savings and
Costs. RAND, page 79.
14 Federico Girosi, Robin Meili, and Richard Scoville (2005), Extrapolating Evidence of Health Information Technology Savings and
Costs. RAND, page 36.
15 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia JohnsonChronic Conditions: Making the Case for Ongoing Care
(2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
16 Center on an Aging Society at Georgetown Univeristy, Disease Management Programs: Improving Health and while Reducing
Costs?, p4, (January 2004). http://hpi.georgetown.edu/agingsociety/pdfs/management.pdf
17 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia JohnsonChronic Conditions: Making the Case for Ongoing Care
(2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
18 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia JohnsonChronic Conditions: Making the Case for Ongoing Care
(2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
19 CMS. (February 2007). National Health Expenditures; Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia
JohnsonChronic Conditions: Making the Case for Ongoing Care (2004). Partnership for Solutions (Johns Hopkins and Robert Wood
Johnson Foundation).
20 National Committee for Quality Assurance (2006), The State of Health Care 2006,
http://www.ncqa.org/communications/sohc2006/sohc_2006.pdf
21 Jeanne M. Lambrew, (April 2007). A Wellness Trust to Prioritize Disease Prevention. The Hamilton Project, Brookings Institution.
http://www3.brookings.edu/views/papers/200704lambrew.pdf
22 Kenneth Thorpe (January 21, 2004), The Medical Malpractice ‘Crisis’: Recent Trends and the Impact of State Tort Claims, Health
Affairs, http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.20v1/DC1#39
23 Department of Health and Human Services (March 3, 2003), Addressing the New Health Care Crisis: Reforming the Medical
Litigation System to Improve the Quality of Care, http://aspe.hhs.gov/daltcp/reports/medliab.htm
24 Edward Langston, “Statement of the American Medical Association to the Senate Committee on the Judicary, United States Senate”
(September 6, 2006). Testimony.
25 Kaiser Family Foundation and Health Research and Educational Trust. (2006). Employer Health Benefits 2006,
http://kff.org/insurance/7527/index.cfm
26 Karen Davis, Cathy Schoen, Stuart Guterman et al. (January 2007), Slowing the Growth of U.S. Health Care Expenditures: What
are the Options? Commonwealth Fund
27 Forbes.com, 2007 CEO Executive Compensation – Health Care Equipment & Services,
http://www.forbes.com/lists/2007/12/lead_07ceos_CEO-Compensation-Health-care-equipment-services_9Rank.html
28 Glenn Hackbarth, Medicare Payment Advisory Commission (April 11, 2007), Testimony: The Medicare Advantage Program and
MedPAC Recommendations, U.S. Senate Committee on Finance,
http://www.medpac.gov/publications/congressional_testimony/041107_Finance_testimony_MA.pdf?CFID=6602154&CFTOKEN=81
609996
29 Karen Davis, Cathy Schoen, Stuart Guterman et al. (January 2007), Slowing the Growth of U.S. Health Care Expenditures: What
are the Options? Commonwealth Fund.
30 Patented Medicine Prices Review Board, Annual Report (Ottawa, Ontario: PMPRB, 2002), p. 23.
31 Marc Kaufman (April 25, 2006), “Drug Firms’ Deals with Allowing Exclusivity,” Washington Post,
http://www.washingtonpost.com/wp-dyn/content/article/2006/04/24/AR2006042401508.html
32 Families USA (December 2005), Falling Short: Medicare Prescription Drug Plans Offer Meager Savings,
http://www.familiesusa.org/assets/pdfs/PDP-vs-VA-prices-special-report.pdf
33 Roger Hickey & Jeff Cruz (April 2007), Waste and Inefficiency in the Bush Medicare Prescription Drug Plan: Allowing Medicare
to Negotiate Lower Prices Could Save $30 Billion a Year, Institute for America’s Future,
http://cdncon.vo.llnwd.net/o2/fotf/medicare/National_Savings.pdf
34 Mark W. Stanton and Margaret Rutherford (June 2006), The High Concentration of U.S. Health Care Expenditures. Agency for
Healthcare Research and Quality. Research in Action Issue 19.
35 Mark W. Stanton and Margaret Rutherford (June 2006), The High Concentration of U.S. Health Care Expenditures. Agency for
Healthcare Research and Quality. Research in Action Issue 19.
36 Census Bureau, “Census Bureau Revises 2004 and 2005 Health Insurance Coverage Estimates,” March 23, 2007.
http://www.census.gov/Press-Release/www/releases/archives/health_care_insurance/009789.html
37 Census Bureau (2008), Income, Poverty, and Health Insurance Coverage in the United States: 2007. Table C-1.
38 Gerard Anderson, Robert Herbert, Timothy Zeffiro, and Nikia JohnsonChronic Conditions: Making the Case for Ongoing Care
(2004). Partnership for Solutions (Johns Hopkins and Robert Wood Johnson Foundation).
39 CDC, http://www.cdc.gov/nccdphp/overview.htm
40 CDC, http://www.cdc.gov/nccdphp/press/index.htm
41 NIH, Childhood Obesity, June 2002 Word on Health http://www.nih.gov/news/WordonHealth/jun2002/childhoodobesity.htm
42 CDC National Center for Health Statistics, http://www.cdc.gov/nchs/pressroom/06facts/obesity03_04.htm
43 GAO (2003), School Lunch Program: Efforts Needed to Improve Nutrition and Encourage Healthy Eating,
http://www.gao.gov/new.items/d03506.pdf
44 The Robert Graham Center (October 2003), http://www.graham-center.org/x468.xml; Institute of Medicine (2002), The Future of
the Public’s Health in the 21st Century, p.364.
45 Bob Prentice and George Flores (December 15, 2006), Local Health Departments and the Challenge of Chronic Disease: Lessons
From California, NIH, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1832141
Roman Catholic Church’s Revised Business Plan
For Increasing Market Share:
1. Do not take a position on birth control, abortion, or homosexuality.
2. Prosecute and dismiss clergy who are sex offenders.
3. Eliminate the male dominated culture. Let woman be priests and men be nuns.
4. Use fair compensation and benefits for nuns equal to priests
5. Create a Reformed movement modeled after the Jewish Reformed movement.
6. Spend more financial resources on social and educational based programs.
7. Stay away from judgmental and vilifying statements.
8. Let followers be selective about what they choose to believe.
9. No ex-communication for: divorce, abortion, birth control, adultery.
10. Vatican should be more humble about accepting constructive criticism and change.
11. Do not get involved in political issues unless they support the improvement of human rights.
12. Do not support the traditional confession model. No more: “Three hail Mary’s” and write a check for forgiveness.
a. In a late April poll by the Forum on Religion and Public Life at the Pew Research Center, Catholics, 50 percent to 28 percent, approved of Notre Dame’s invitation to Mr. Obama. Approval among weekly churchgoers, when Hispanics were included, was as high as disapproval. For Catholics, the more important Pew study, also released in April, examined changes in Americans’ religious affiliation over their lifetimes. It found that for every adult entering the Catholic Church from another religious background, four were leaving. Catholicism has held its own as a percentage of the population only because of immigration, especially from Latin America, and higher birth rates.
1. Do not take a position on birth control, abortion, or homosexuality.
2. Prosecute and dismiss clergy who are sex offenders.
3. Eliminate the male dominated culture. Let woman be priests and men be nuns.
4. Use fair compensation and benefits for nuns equal to priests
5. Create a Reformed movement modeled after the Jewish Reformed movement.
6. Spend more financial resources on social and educational based programs.
7. Stay away from judgmental and vilifying statements.
8. Let followers be selective about what they choose to believe.
9. No ex-communication for: divorce, abortion, birth control, adultery.
10. Vatican should be more humble about accepting constructive criticism and change.
11. Do not get involved in political issues unless they support the improvement of human rights.
12. Do not support the traditional confession model. No more: “Three hail Mary’s” and write a check for forgiveness.
a. In a late April poll by the Forum on Religion and Public Life at the Pew Research Center, Catholics, 50 percent to 28 percent, approved of Notre Dame’s invitation to Mr. Obama. Approval among weekly churchgoers, when Hispanics were included, was as high as disapproval. For Catholics, the more important Pew study, also released in April, examined changes in Americans’ religious affiliation over their lifetimes. It found that for every adult entering the Catholic Church from another religious background, four were leaving. Catholicism has held its own as a percentage of the population only because of immigration, especially from Latin America, and higher birth rates.
Words Don’t Always Lead to Actions
Words Don’t Always Lead to Actions
“PRO LIFE”
These folks generally don’t support: stopping capital punishment, aid for prenatal care, family planning, environmental responsibility, detente, assault weapon control, aid to improve mental and physical health, stem cell research, research for improved medical care, etc.
“SUPPORT OUR TROOPS”
These conservative legislators generally voted down: increased funding for battlefield armor, increased veterans benefits, better medical care and conditions at VA hospitals, increased treatment for Post Traumatic Distress.
“CONSERVATIVE”
Def: disposed to preserve existing conditions, institutions, etc., or to restore traditional ones, and to limit change. To limit the influence government and fiscal spending.
These conservative politicians generally supported: increased censorship on the arts, media, and publications. The greatest deficit spending during the G.W. Bush and Reagan eras. The greatest increased power imbalance to the Executive branch in history. The greatest increase in the national debt. Minimal and decreased oversight of our natural resources and the environment ( “TR”, a previous progressive Republican would be turning in his grave). Resistance to creating energy efficiency and sustainability. Support continued disparity in pay for men and women. Increased influence of evangelical agenda in legislation. Hypocritical attitudes about “States Rights”
“COMPASSIONATE Conservative”
Little or no Compassion, just an OXIMORON to hoodwink people in the middle.
“REPUBLICANS are BEST for ECONOMIC GROWTH”
Data and metrics clearly prove that: geographic areas of greatest economic growth and affluence tend to be more progressive and liberal minded. Tolerance and acceptance stimulates the economy. During more liberal administrations: unemployment was lower, the return on stocks was higher, the economy was more robust, general economic indicators were greater, spending on defense was lower, the economic playing field for all Americans was more fair. The was less Fear Mongering. Liberals don’t always promote Big Government.
“Traditions should always be embraced”
Traditions are many times anti-societal and regressive: Segregation, misogynistic laws, lack of non-inclusive legislation, support of homophobic attitudes in society and the military. That our best knowledge is from a mythical story book thousands of years old, as opposed to deductive reasoning and the scientific method. Only people who practice an organized religion are moral. Women are inferior to men. The only real solution to discord is violence.
“PRO LIFE”
These folks generally don’t support: stopping capital punishment, aid for prenatal care, family planning, environmental responsibility, detente, assault weapon control, aid to improve mental and physical health, stem cell research, research for improved medical care, etc.
“SUPPORT OUR TROOPS”
These conservative legislators generally voted down: increased funding for battlefield armor, increased veterans benefits, better medical care and conditions at VA hospitals, increased treatment for Post Traumatic Distress.
“CONSERVATIVE”
Def: disposed to preserve existing conditions, institutions, etc., or to restore traditional ones, and to limit change. To limit the influence government and fiscal spending.
These conservative politicians generally supported: increased censorship on the arts, media, and publications. The greatest deficit spending during the G.W. Bush and Reagan eras. The greatest increased power imbalance to the Executive branch in history. The greatest increase in the national debt. Minimal and decreased oversight of our natural resources and the environment ( “TR”, a previous progressive Republican would be turning in his grave). Resistance to creating energy efficiency and sustainability. Support continued disparity in pay for men and women. Increased influence of evangelical agenda in legislation. Hypocritical attitudes about “States Rights”
“COMPASSIONATE Conservative”
Little or no Compassion, just an OXIMORON to hoodwink people in the middle.
“REPUBLICANS are BEST for ECONOMIC GROWTH”
Data and metrics clearly prove that: geographic areas of greatest economic growth and affluence tend to be more progressive and liberal minded. Tolerance and acceptance stimulates the economy. During more liberal administrations: unemployment was lower, the return on stocks was higher, the economy was more robust, general economic indicators were greater, spending on defense was lower, the economic playing field for all Americans was more fair. The was less Fear Mongering. Liberals don’t always promote Big Government.
“Traditions should always be embraced”
Traditions are many times anti-societal and regressive: Segregation, misogynistic laws, lack of non-inclusive legislation, support of homophobic attitudes in society and the military. That our best knowledge is from a mythical story book thousands of years old, as opposed to deductive reasoning and the scientific method. Only people who practice an organized religion are moral. Women are inferior to men. The only real solution to discord is violence.
“Food for Thought”
“Food for Thought”
I have been trying to reflect on the unrest in the Middle East as impartially as I can, as both a non-practicing Jew who visited Israel over 30 years ago and a secular humanist. I feel we need to bring our behavior and actions “home” before we judge and condemn the actions of others.
For me what it comes down to is: (1) until we can recognize the civil rights of all people; (2) not demonize other nationalities, religious & ethnic groups, gender orientations, or political affiliations; (3) abide by the “Golden Rule”; (4) not believe we have the divine right to take the land or assets of other nations, ethnic groups, etc. without just and fair compensation and permission; (5) make a sincere and caring attempt to listen to those who are not in total agreement with us; (6) accept that we live an abundant universe where we don’t have to live in fear of having to hoard: food, money, land, and material possessions; (7) not try to convince ourselves that the lives of the peoples of: one nation, religion, gender, ethnic group are any more or less valuable than our own. Until we can embrace and embody the above concepts, we will always have wars and world conflict.
In the 13th century in the time of the Inquisition, non-Christian’s were labeled “infidels” and slaughtered, today a small group of Muslims label others as “infidels”. During the Nazi occupation of Europe the Jews, Gypsy’s, and homosexuals we labeled as “Vermin” and killed. During the “9/11” tragedy, George Bush said,” if you are not with us you are against us”, inferring that those who did not agree with him were also “evil doers”. The Mormons say that if you are not one of us, you will not be saved, therefore inferring non-Mormons will go to hell.
“One man’s freedom fighter is another man’s terrorist”. During the Revolutionary War, Colonists fought back against the British in a Terrorist Guerilla like fashion. During WW II Jews in the Warsaw Ghetto fought against the Nazi’s in a terrorist like fashion. After centuries of slavery and oppression some African American’s in the 60’s created violent extremist groups such as the “Black Panthers”, “Black Muslims” to finally vent their anger, and try to create a boundary of self respect. Today in the Middle East some frustrated Palestinian’s have created an extreme group called Hamas. The end result of the above was divisiveness, violence, and death. I don’t condone the actions of either side in the Middle East, but I do have empathy and an understanding of why they are behaving in such an inhumane manor. The Palestinians’ feel disrespected, locked in a ghetto type environment, and forced to live like animals in a penned up situation. The Israeli’s who are Jews who’s parents and ancestors were persecuted, had their possessions stolen, and were exterminated in one of history’s major holocausts’ are saying “Never Again”, we will not lie down passively like we have done in past centuries, be herded around like animals, packed into ghetto’s, and exterminated. Much of the suffering and death in the past has been carried out by power hungry, greedy, extremist despots in the name of religion, ethnicity, mass fear, etc.
Getting back to the present decade, do we wage war on an entire nation because a dozen extreme angry individuals hijacked some planes and drove them into the Twin Towers and killed thousands of people, or do we treat them as criminals? If a few hundred “African Americans” due to their anger and frustration waged a destructive riot in Watts do we bomb entire neighborhoods of people of color? It is probably more expedient in the short run to kill off hundreds of Palestinian civilians in Gaza, then to bring to justice just those who have launched rockets into Israel. But if we value the lives of all people equally, take time to listen and empathize, and not condemn those who are not like us, then we have a much greater chance for world peace.
I have been trying to reflect on the unrest in the Middle East as impartially as I can, as both a non-practicing Jew who visited Israel over 30 years ago and a secular humanist. I feel we need to bring our behavior and actions “home” before we judge and condemn the actions of others.
For me what it comes down to is: (1) until we can recognize the civil rights of all people; (2) not demonize other nationalities, religious & ethnic groups, gender orientations, or political affiliations; (3) abide by the “Golden Rule”; (4) not believe we have the divine right to take the land or assets of other nations, ethnic groups, etc. without just and fair compensation and permission; (5) make a sincere and caring attempt to listen to those who are not in total agreement with us; (6) accept that we live an abundant universe where we don’t have to live in fear of having to hoard: food, money, land, and material possessions; (7) not try to convince ourselves that the lives of the peoples of: one nation, religion, gender, ethnic group are any more or less valuable than our own. Until we can embrace and embody the above concepts, we will always have wars and world conflict.
In the 13th century in the time of the Inquisition, non-Christian’s were labeled “infidels” and slaughtered, today a small group of Muslims label others as “infidels”. During the Nazi occupation of Europe the Jews, Gypsy’s, and homosexuals we labeled as “Vermin” and killed. During the “9/11” tragedy, George Bush said,” if you are not with us you are against us”, inferring that those who did not agree with him were also “evil doers”. The Mormons say that if you are not one of us, you will not be saved, therefore inferring non-Mormons will go to hell.
“One man’s freedom fighter is another man’s terrorist”. During the Revolutionary War, Colonists fought back against the British in a Terrorist Guerilla like fashion. During WW II Jews in the Warsaw Ghetto fought against the Nazi’s in a terrorist like fashion. After centuries of slavery and oppression some African American’s in the 60’s created violent extremist groups such as the “Black Panthers”, “Black Muslims” to finally vent their anger, and try to create a boundary of self respect. Today in the Middle East some frustrated Palestinian’s have created an extreme group called Hamas. The end result of the above was divisiveness, violence, and death. I don’t condone the actions of either side in the Middle East, but I do have empathy and an understanding of why they are behaving in such an inhumane manor. The Palestinians’ feel disrespected, locked in a ghetto type environment, and forced to live like animals in a penned up situation. The Israeli’s who are Jews who’s parents and ancestors were persecuted, had their possessions stolen, and were exterminated in one of history’s major holocausts’ are saying “Never Again”, we will not lie down passively like we have done in past centuries, be herded around like animals, packed into ghetto’s, and exterminated. Much of the suffering and death in the past has been carried out by power hungry, greedy, extremist despots in the name of religion, ethnicity, mass fear, etc.
Getting back to the present decade, do we wage war on an entire nation because a dozen extreme angry individuals hijacked some planes and drove them into the Twin Towers and killed thousands of people, or do we treat them as criminals? If a few hundred “African Americans” due to their anger and frustration waged a destructive riot in Watts do we bomb entire neighborhoods of people of color? It is probably more expedient in the short run to kill off hundreds of Palestinian civilians in Gaza, then to bring to justice just those who have launched rockets into Israel. But if we value the lives of all people equally, take time to listen and empathize, and not condemn those who are not like us, then we have a much greater chance for world peace.
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