Progressive Populism for the 21st Century

Populismo Progresista para el Siglo XXI!!!

Rw005g

Rw005g
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Strategos
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Defender of the Old Republic, and member of the 99%

MY RECENT POSTS

JANUARY 4, 2011 10:58AM

MEDICARE-MEDICAID TROJAN HORSES

Rate: 17 Flag

I am reading a few books right now about President Johnson and the Great Society. I think it was a good idea, but it failed in some minor ways, particularly in terms of how it let corporate interests hijack the Progressive Agenda.

 Don't get me wrong. I am a Progressive, but my readings are telling me that many of  the programs enacted by the Great Society, while aimed at helping the poor, the elderly and the sick, may actually have hurt them because these programs were not "progressive enough," and because the Aristocracy and Special Interests were able to insert DEADLY TROJAN HORSES into various pieces of legislation, so as to DESTROY both their EFFICACY and LONG-TERM LEGITIMACY.  

My readings are showing me that many of these programs, in order to withstand conservative attacks, had to make so many compromises with the corporate and special interest wings of the Democratic and Republican parties, that the long-term efficacy of said programs was bound to decline. And not for the reasons the GOP and conservatives said.

 My readings about the legislative maneuverings and Realpolitik of the Great Society are showing a few interesting trends.

First, LBJ was able to get many of these programs passed in a "consensus" rather than true "redistribution" manner. This means that rather than centralize and redistribute public goods on the basis of pure need, the benefits were aimed at the appearance of need, but various corporate interests were allowed to have their hand in the cookie-jar, so that the vast majority of the intended beneficiaries of said programs never received as much as the programs intended them to receive. Further, this level of corporate/special interest collusion led to the long-term erosion in the efficacy of said benefits, such that, when coupled with inflation and the declining power of wages, the programs seemed, increasingly, to be doing more harm in some ways than good.

The most salient example of this is in terms of cost: LBJ and the Democrats allowed the Companies and Interests to dictate the costs of many of these programs and there were no benchmarks or price-controls, such that these progams became, in many ways, additional udders upon which the corporate parasites could feed and become bloated, without many benefits accruing to the needy for which these programs were originally intended.

Let's look at Medicare/Medicaid as an example. Many of my readings of both right and left-wing publications seem to indicate that the greatest beneficiary here weren't the poor or the elderly, but the American Medical Association. The AMA was staunchly opposed to Medicaid and Medicare from the getgo, fearing "socialized medicine" would destroy the cherished class-position and wealth of countless doctors and family-based doctor dynasties, where grandfathers, fathers and sons all became doctors and went to the same schools and amassed huge treasuries of family wealth and privilege.

In any event, the AMA was able to persuade many Congressmen that they should ONLY support the bill for Medicare/Medicaid if there were NO PRICE CONTROLS over hospitals or physicians. Previously, without government spending, hospitals were forced to keep prices down, because people had limited ability to pay. The PRICE-CONTROL or PRICE-BARGAINING prohibition extracted  by AMA-controlled Congressmen (who were, in effect, nothing but Prostitutes or Rent Boys working for unethical AMA Pimps) ensured that the Medicare/Medicaid Act, rather than being a true piece of Progressive Legislation, would actually be a PARASITIC BILL, Clothed in the Guise of Progressive Legislation.

Don't get me wrong. Many folks have benefited in numerous ways from these programs. I think these programs are good, beneficial and should be EXPANDED. That said, this PRICE-CONTROL Prohibition seems to have caused COUNTLESS HORRORS, and PREVENTED THE TRUE BENEFITS OF SOCIALIZED MEDICINE FROM BEING REALIZED.

The lack of price-controls, and the prohibition on Government Price-Negotiations ensured that Hospitals would OVERCHARGE for procedures and treatment, because they would be ENSURED PAYMENT by a CAPTIVE GOVERNMENT SUBROGEE (in law, a subrogee is somebody who is legally bound to pay on the behalf of another. In insurance, the insurance company or Medicare is the subrogee for the individual receiving the treatment).

This led, in many ways, to SKYROCKETING HEALTH CARE COSTS and OVERALL INFLATION throughout the medical treatment industry. Hospitals felt that they could raise-prices across the board, because government and other insurance companies would pick up the tab. Further, those without private or public health insurance, namely, THE WORKING POOR, would be CRUSHED IN A VICE GRIP. They had no Subrogee paying their medical bills, but they faced INCREASING MEDICAL COSTS. As such, these would be the folks forced into poverty and bankruptcy by the resulting MEDICAL INFLATION.

Worse, still, the Medical Price Inflation often became so severe, over the past 40 years, that it ATE INTO THE BENEFITS conveyed by Medicare/Medicaid. This happened in much the same way that monetary inflation eats into the raises that many of us and our parents received at work. The benefit means nothing if the external economic forces are eradicating its efficacy from without.

Apparantly, by inserting this clause into the legislation, the Conservatives utilized a CORPORATE TROJAN HORSE STRATEGY.

Not only would they be able to PROFIT FROM the new programs, but they would also be able to have a PRETEXTURAL REASON, down the line, for (a) arguing that the programs are inefficient, (b) ineffective and (c) should be abolished.  

The second interesting thing is how the corporate/special interest elite approached the politics of consensus from a tactical perspective. These elites pursued a legislative policy of consensus with their left hand and opposition with their right hand. If the law passed, the Corporations would be happy that they made a great deal of money from the new liberal policies.

Here, the AMA publicly opposed the Medicaid/Medicare bills, but secretly worked behind the scenes to ensure that IF IT PASSED, hospitals would win nonetheless.

 I have to read more about other GREAT SOCIETY programs, but my experience in the Insurance Industry and Public Defender's Office has shown me the dangers that often occur when there is UNHOLY COLLUSION BETWEEN GOVERNMENT AND CORPORATIONS.

I remember the story about the Juvenile Delinquent Treatment Facility in Pennsylvania. Here, the taxpayers created a progressive program where kids could be treated for behavioral disorders, rather than go to jail. The Facility was run by a private company. Apparantly, the company bribed various lawyers and judges into steamrolling numerous innocent kids into these camps, irrespective of need or the presence of actual behavioral problems. The company received tens of thousands of tax-payer dollars for each kid they received and they wanted as many kids pushed into these camps as possible. IT WAS COLLUSION OF THE WORST AND MOST REPREHENSIBLE SORT.

Oftentimes, policies that say they are aimed at helping the poor or the sick or the troubled, are actually aimed at HELPING THE RICH. Worse, the Rich use this fact as a justification for abolishing the program/policies altogether, which IS NEVER THE SOLUTION.

WHAT IS THE SOLUTION? We must weed/rake through every piece of progressive legislation and find the CORPORATE TROJAN HORSE within, the clause or section that is the #1 Cause for the programs lack of efficacy.

MEDICARE and MEDICAID can be saved----the entire HEALTH CARE INDUSTRY itself can be saved from the ravages of INFLATION if we remove this special AMA-SANCTIONED CLAUSE.

I have also noticed that the insurance industry is often FIGHTING with the American Medical Association over costs. Doctors want higher costs and the insurance industry wants lower costs. PRICE CONTROLS would help both CONSUMERS and the INSURANCE INDUSTRY.

"Aside from middle-class old persons protected from the financial ravages of long illness, the clearest beneficiaries of Medicare and Medicaid were doctors, who, according to one estimate, enjoyed an average income gain of $3,900 in 1968 as a result of these programs. Medicare-Medicaid, then, primarily transferred income from middle-class tax-payers to middle class health care professionals. In this way, once again, the politics of consensus prevailed over the policy of redistribution." (The Unravelling of America: A History of Liberalism in the 1960s," by Allen J. Matusow, page 232).

THE MORAL OF THE STORY: Socialized Medicine and/or government control and/or interference in health care DIDN'T RUIN Medicare/Medicaid or the Health Care Industry in General.

RATHER----it was CORPORATE TROJAN HORSES that brought down and that are continuing to bring down the MEDICAL CARE SYSTEM in America.

Rather than abolish these programs, we should ANNIHILATE, PURGE and EVISCERATE these TROJAN HORSES.

REDISTRIBUTIONIST POLICIES have always been tempted to forge CONSENSUS COALITIONS with Large Companies. The problem is that these "HELPFUL" companies are often intent on one thing alone: DELIVERING A TROJAN HORSE.

Perhaps President Obama should obey the warnings of old, and

BEWARE OF GREEKS BEARING GIFTS.

OR, as they said in Latin: Timeo Danaos et dona ferentes

Oftentimes, in negotiations and "compromises," the pound of meat you deliver to the enemy often contains the seeds of your own undoing. The more sophisticated the foe, the more likely this is the case.

BEWARE OF CONGRESSIONAL "RENT BOYS"

http://en.wikipedia.org/wiki/Rent_boy

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You know I come from the land of free health care. This all boggles my mind why there is such a fight.
:(
rated with hugs
Yes, and they did the same with the healthcare bill by getting rid of a competitive gov't program....
Of course further price controls over Medicare/Medicaid (it's not true that there aren't any, the main one being the government limiting of reimbursement to a set portion of the market price for a doctor's care), would come today in the form of limitations on access. This is not a 'trojan horse' argument, it's quite real, and it's the real reason why doctors who provide care for the poor opposed key provisions in the healthcare bill, even while they supported a more regular public option that would have included anyone. In the present political climate, reopening the debate on Medicare/Medicaid will only limit access for more people. The present bill should be defended, and progressive caucus members in the House and Senate should introduce a companion package to reopen negotiations with drug companies for lower prices for government healthcare recipients. Other than that, the debate should be kept closed for now. Any other suggestion is reactionary, and is itself a trojan horse waiting on budget cuts.
Rated.
Boko: that is very interesting and strategically erudite.
I would go further, and point out that the reason the American healthcare system has such high prices is that it's a 100% provider based system. In most systems, people who are very sick or need to see someone right away are provided care from a physicians network, while people who suffer from a chronic illness are seen by specially trained practitioners--RN's and medical aides who are trained in long-term care for that particular illness.

Physicians networks have consistently opposed moving off of physician-based care because it threatens their monopoly on business. Sometimes their own members oppose this, and some networks have actually partnered with practitioner networks to set up a more care-appropriate, and cost-effective approach. It works better for the chronically ill, too. They're able to see practitioners more often than they could see physicians, and they still have access to physicians when they really need them. If cost is really the issue--and not profits--this is the sort of system we should have. In the long term, of course, it would keep costs down as well.
Boko: For any folks who read this, please distinguish between a provider-based and physician-based system. This is interesting.
And by the way cost and profit are not two sides of the same coin. Business 101 you know...

And the chronically ill make up the vast majority of people seen on a regular basis in any system, so the issue is the rule rather than the exception. Drugs make up the largest part of their healthcare costs, so having the government negotiate down with drug companies would be the single best way to reduce government healthcare costs without limitig access--that is, short of reforming the entire system and making it practitioner-based.
I agree 100% with the drug cost thing. But still, please elaborate and/or describe the distinction I point out above. 8)
The distinction should be between a physician based system--where you're sick, you see a doctor, they diagnose and treat you, and then later you come for a follow up--and practitioner based--where if you're sick and need a diagnosis right away, you have access to a physician, but if you're chronically ill and need to see someone on a more regular basis, practitioners provide most of the care. The latter model is better for everyone: it reduces wait times on physician visits because the chronically ill are seen by practitioners, and the chronically ill get more constant care. The chronically ill are also far healthier over time in a practitioner based system. There's more time spent on their needs, they get better preventive care, and there's less overlapping care and less chance of making mistakes on drug combinations, missed diagnoses between visits etc.
Will be back when I got the time. Got to run here. Bookmarked....
I was not aware of the Trojan horses. How much greed can we afford.
Linda is right, it boggles my mind that people can have free healthcare just across the border and we, supposedly the richest nation cannot.
Thanks for this well thought out and researched post.
rated with amazement
With insurance company profits now supposedly limted to 20%, a major way to increase their bottom line will be to encourage higher costs. Runaway medical expenses will be the insurance company's best friend.
This seems on first reading to be yet another way that big business (here meaning the medical industry) has pillaged the government and drained the economy. We have no farther to look for our current economic situation than the companies that supposedly serve us.

And regarding the doctor vs practitioner discussion, my view is that the difficulty of getting into med school equals a planned monopoly of medical information. There is lip service given to the idea that patients should participate in their own medical decision-making, but without understanding the purposefully obtuse information, we are dependent on the doctors' advice. If there were more college programs with medic-level training, and expanded use of nurses, the current "doctor shortage" and just poor service in seeing a physician would disappear.
Of course the RX drug bill was also passed with no price controls, though other aspects of health care now have them. Huge boondoggle.
Ardee - I would agree, but the fact is that the current shortage is not a matter of pure numbers, it's a matter of specialty and the requirements of a physician based system. Providing more nurses and other practitioners would be swell, but patients would still have to see a doctor no matter what. That's an enormous waste, and it doesn't provide the best care to the chronically ill who need more than a five minute visit.
Ardee: I echo Boko and say this: the influence and corrupting tentacles of corporate America creep their way into every hole and oriface of every bill ever passed in Congress. We need extra-special strainers to keep their crud out of our legislation.
This should be plastered on the walls of every men's room or women's room from here to Timbuktu. As it is essential we get the message out, where would you suggest I might want to write to begin this dialog in earnest?
Very Highly Rated
PW: As Boko says, we need to be careful that this critique isn't used by the GOP or 5th Columnist Dems to destroy Medicare/Medicaid altogether.

We just need to look at this and see it as an example, a template the ELITES will use in all future legislation.


And whenever we try to solve problems, we need to look for TROJAN HORSES. They may not always exist and they may not always be the problem. BUT---they do exist here and there, every now and then. And we need to purge them and their benefactors when we find them.
Great post and great research. I really don't think anyone really knows whats in the new health care bill. Written like legalese, you have to be a doctor and lawyer to figure it out. You can bet your ass it's filled with "Trojan Horses". Thanks for this my man, we need people like you who can at least know which way the bullshit is blowing!
BOKO, we are in complete agreement, though the stricture that you have to see a doctor first isn't a law, or even a required practice unless you have health insurance - nice little circle jerk, there. Free health clinics usually use nurses and other medics to do the main work. And you are also right about the doctor shortage being due to specialization, since that's where the money funnels into doctor pockets. Family practice docs are usually losing money unless they keep a breakneck schedule seeing patients for 5 minutes at a time. I should know - I'm the daughter, sister and niece of doctors.
Hey RW, I bet you have a strainer in mind, and I just need to read your back posts to find it. I am betting I will love it.
Ah, Greed....
where would we be without it, driving industry and
trickling down its dividends
to the very sickest.

New diseases spring up every day, i have noticed.
And new drugs, too.
Wish one of them would cure greed.

It's all about greed for life.
Anything goes in this social Darwinian world.
Anything, anything, to build up a castle of immortality.
A big bank account is immortality, to the terminally mortal.

Beyond greed, once it has ruined everything,
is progressive peace.
Peace out, as they say.
Out of this nightmare.

At least you know it is a nightmare, and are awake.
Fine post, bringing the nightmare to the point where we
wake up or roll on our other side and keep dreaming.
Ah, Greed....
where would we be without it, driving industry and
trickling down its dividends
to the very sickest.

New diseases spring up every day, i have noticed.
And new drugs, too.
Wish one of them would cure greed.

It's all about greed for life.
Anything goes in this social Darwinian world.
Anything, anything, to build up a castle of immortality.
A big bank account is immortality, to the terminally mortal.

Beyond greed, once it has ruined everything,
is progressive peace.
Peace out, as they say.
Out of this nightmare.

At least you know it is a nightmare, and are awake.
Fine post, bringing the nightmare to the point where we
wake up or roll on our other side and keep dreaming.
The biggest beneficiary of Medicare are physicians and from Medicaid, nursing home owners. R
I'm with Linda. The U.S. is insane.

Romantic - our health care isn't free, of course. We pay for it thru taxes. But that comes from (sorry for commie slogan here) from each according to their ability and to each according to their need. Health care is covered out of a big common pool. And it costs less per capita than what America pays overall for health care. And covers everyone, equitably.

I simply do not understand why Americans don't riot in the streets demanding this system....or even why polluted corrupted politicians withhold this from their constituents.

I don't see how y'all can fiddle and sort-of fix the ridiculous system you have. Governmental system too - I'm an advocate of the parliamentary system, which puts elected reps in their place...and makes bribery a waste of time...
There was an extremely strong single payer (national health care) movement in 1964, just as there was in 1992 when Clinton tried to ram federal managed care down our throats and in 2008. I know because I was part of the movement in 1964, and it was the national debate topic for high school debating teams. The movement was so strong, Johnson had to do something - so he gave us a worthless compromise (Medicare and Medicaid), just as Clinton and Obama tried to give us worthless compromises

The problem with guaranteeing universal health care to a small subset of the population is that it never lasts. These cut-out programs are always the first to be cut in any budget balancing act.

The secret is to pass a single health care program that covers everyone. That way everyone - Republicans, Democrats, libertarians, and corporate executives - will want to make sure that it stays well-funded. Because they just might have to use it when they get sick.
I've got nothing to add. Good work by both you and Boko.
As a physician I should be incensed by the current state of our healthcare system. But I say, fuck it. I'm too old to worry too much about anything other than painkillers. And they're still on the public formulary, although some states have started limiting the number of monthly refills of opioids to 4 or 5. Outrageous!
rate
Our nation does not create a public good but an opportunity for profit. It was business as usual for Bush et al to make the gift to Big Pharma of the Medicare Rx "benefit". When the US gives foreign aid, we require them to buy more expensive US made goods so it returns 80% of what we "give".
We need a basic change. Our citizens need more brains...
Scanner: One of the things I propose is a national convention to alter the way laws are written, so that they can be understood by the common man.

Mr. Sunshine: Greed destroys the solution to the collective action problem and is the major reason we are in the current mess. I agree with you 100%

David Price: Many of these folks are scumbags. My grandma was in a nursing home and assisted living center and they were greedy, indifferent bastards. She was convalescing from open heart surgery and became incontinent and they would let her sit and sleep in her own human waste for days on end. Often, she would go a week without being bathed. And yet, they were so Prussian with their love of rules, they would tell you when you could and couldn't leave, they wouldn't give her PT, would evade her doctor and seemed to want to keep her in a vegetative state, so they could keep making money from Medicare. Greedy bastards, all of them.
Myriad: America seems to have become a nation of mentally-numb, catatonic lemmings. 80% of the time we are asleep, and 20% of the time we are awake. However, when we are awake, we are so conditioned to behave like a mass of unthinking, mentally numb lemmings that we often jump off of cliffs, or run into pits of burning lava, chasing after red-herring "windmills" constructed for us by the Elite and Aristocracy.

We need to awaken the nation. RABBLE ROUSING is a good start.
Dr. Bramhall: This is why I so love Salon. I am in my early 30s and my family has very little political/professional knowledge. So much of this is new to me. I love listening to veteran rights-activists and politically conscious folks from the baby boom generation. So much insight is to be gained from listening to you guys. Salon is crucial in this way, methinks. It preserves your insights for all time, so that my generation and my grandchildren can benefit from the wisdom of the baby boomers.

My generation needs to act soon, though. Wisdom without Works is false route to Zion.
Very interesting analysis. I largely agree. rated.
Sal: Thanks. Boko thanks you, too! His insights and policy knowledge in this area have been most helpful for this posting. It has contributed greatly to this discussion.
Dr. Lee: I fear that in time, painkillers will be the only meds given out by the insurance industry and their GOP/Corporate Dem Rent Boys in Congress. Rather than treat the illness, they will just drug us up to keep us numb and quiet, so we die an inconspicuous death
O'Stephanie: We must agitate, agitate, agitate, antagonize, antagonize and antagonize.

I think our #1 problem is that Liberals can't find ways to make their beliefs appealing to normal folks. We aren't "folksy" enough, in the way that Left Wing Populists like Chavez, Gueverra, Castro and others are.

We need HUEY LONG not ADLAI STEVENSON.

Adlai Stevenson-types have actually SOLD-OUT the Progressive Movement. SCREW THEM and the HORSE THEY RODE IN ON.
In light of the fate of his predecessor it’s hard to imagine that LBJ was not compromised when he took office and fully aware of the built in sabotage provided for these “social reforms”. Americans are in the throes of a fatal collective insanity induced by the corporate controlled media. The first politician who even brought up the subject of cutting Medicare, Medicaid, and Social Security should have been dealt with in the same manner the Italians dealt with Mussolini. There is no room for cutting Social Services in a country that terrorizes the earth with a trillion dollar military machine. Sooner or later some bright eyed generals will figure out that the American throne is up for grabs and turn those weapons on the real enemies of America: its politicians, the corporate board rooms, and Wall Street and as long. As they produce a prodigious slaughter I shall support them with every muscle in my body and cell in my brain!
This is the capture theory in part, which always happens somewhat.
Thinking of more of a response. Very thought provoking.
Just typed "capture theory" in google and this wiki article came up on "Regulatory Capture." Its a good read. Thank you Mr. Rich!

http://en.wikipedia.org/wiki/Regulatory_capture
After reading that, I think its safe to say that big business has engaged in regulatory capture, not only re: regulatory agencies, but in regard to Congress and the White House as well. How many guys from Goldman-Sachs does Obama have as economics advisors?
ALSO INTERESTING:

http://en.wikipedia.org/wiki/Government_failure

http://en.wikipedia.org/wiki/Crowding_out_(economics)
you are welcome rw.
it is the downside of pluralism in some ways per federalist number 10.
no one interest group is supposed to get totally its own way, which avoids both tyranny and a violent response to it; so everyone gets some slice of the pie.
however, that in turn has the downside that everyone has a slice of the pie, and therefore you can't change anything, which means that if the environment is changing under everyone's feet, in part due to our own actions, then, institutions become brittle, and sometimes outright fail.
two words: CARTEL and OLIGOPOLY. americans cant seem to figure it out. have you read a single informative article about health care that uses these two *highly*relevant* terms? of course not..... deaf,dumb,blind
VZN: Indeed! Most mainstream media publications deny the truth and perpetuate the decades-long con-game that the AMA is a benevolent, altruistic organization purely concerned with the quality of affordable and ethically-disposed health care. lololol
Don Rich: Your arguments here about pluralism and Federalist No.10 are interesting, because they remain the most salient criticism of the arguments I put forth before Christmas, in my article on Civic Associations & Totalitarianism.

Rather than seeing factions/pluralism/organized groups as becoming tools of government oppression, Madison felt that factions could manipulate government, infiltrate it and influence it such that the government would become hostage to the faction and do its bidding.

I think this sentiment by Madison is indicative of his maturing political philosophy, one that gradually took him from the Federalist camp into the arms of Anti-Federalists and their sympathizers, like Thomas Jefferson. These folks believed that a big, centralized government could become a tool of oppression and Woodrow Wilson took this Jacksonian/Jeffersonian/Anti-Federalist line while in the White House.

THIS IS IMPORTANT because we often forget the Woodrow Wilson approach to Progressivism in the modern age. Liberals and Progressives have totally accepted, without question, the Bull Moose/Teddy Roosevelt argument, informed by Hamiltonianism/Federalism, that the only way to stop corporate abuse is to have a big, regulatory government. We forget that there were TWO SIDES OF THE PROGRESSIVE MOVEMENT, one that was HAMILTONIAN and another that was JEFFERSONIAN. TR and FDR espoused the HAMILTONIAN perspective and we forget this geneology when espousing the big-government approach.

I don't disagree with the big gvt approach, but I think we should know all the facts, kind of like how Napoleon wanted to have total 100% situational awareness on a battlefield, the same should be said for debates about policy.

Wilson basically said that bigger gvt agencies would create "Regulatory Capture" situations and this is why you need smaller government. On the other hand, TR said that smaller government would totally cede the playing field to the other side.

What we need is to SYNTHESIZE the two schools. We need big government, but it needs to be BIG in the ways that avoid the criticisms of the JEFFERSONIANS. We need to be big and RESIST THE CORRUPTING INFLUENCES OF BIG MONEY.

This is key. The Wilsonian CRITIQUE IS SALIENT, but his SOLUTIONS ARE NOT. TR's Solutions are, though.

Too bad he dismissed Wilson too much. Wilson wasn't dumb.
The US needs to retitle the new health care bill Greed and Insanity.
Folks might listen up a little.
Everything else has already been said.
There is still no public option at all.
Just insurance companies with bigger bellies.