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“Lethal But Legal”: Rethinking Our ‘Rights’ To Dangerous Behaviors

In the last few years, it’s become increasingly clear that food companies engineer hyperprocessed foods in ways precisely geared to most appeal to our tastes. This technologically advanced engineering is done, of course, with the goal of maximizing profits, regardless of the effects of the resulting foods on consumer health, natural resources, the environment or anything else.

But the issues go way beyond food, as the City University of New York professor Nicholas Freudenberg discusses in his new book, “Lethal but Legal: Corporations, Consumption, and Protecting Public Health.” Freudenberg’s case is that the food industry is but one example of the threat to public health posed by what he calls “the corporate consumption complex,” an alliance of corporations, banks, marketers and others that essentially promote and benefit from unhealthy lifestyles.

It sounds creepy; it is creepy. But it’s also plain to see. Yes, it’s unlikely there’s a cabal that sits down and asks, “How can we kill more kids tomorrow?” But Freudenberg details how six industries — food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive — use pretty much the same playbook to defend the sales of health-threatening products. This playbook, largely developed by the tobacco industry, disregards human health and poses greater threats to our existence than any communicable disease you can name.

All of these industries work hard to defend our “right” — to smoke, feed our children junk, carry handguns and so on — as matters of choice, freedom and responsibility. Their unified line is that anything that restricts those “rights” is un-American.

Yet each industry, as it (mostly) legally can, designs products that are difficult to resist and sometimes addictive. This may be obvious, if only in retrospect: The food industry has created combinations that most appeal to our brains’ instinctual and learned responses, although we were eating those foods long before we realized that. It may be hidden (and borderline illegal), as when tobacco companies upped the nicotine quotient of tobacco. Sometimes, as Freudenberg points out, the appeals may be subtle: Knowing full well that S.U.V.’s were less safe and more environmentally damaging than standard cars, manufacturers nevertheless marketed them as safer, appealing to our “unconscious ‘reptilian instincts’ for survival and reproduction and to advertise S.U.V.’s as both protection against crime and unsafe drivers and as a means to escape from civilization.”

The problems are clear, but grouping these industries gives us a better way to look at the struggle of consumers, of ordinary people, to regain the upper hand. The issues of auto and gun safety, of drug, alcohol and tobacco addiction, and of hyperconsumption of unhealthy food are not as distinct as we’ve long believed; really, they’re quite similar. For example, the argument for protecting people against marketers of junk food relies in part on the fact that antismoking regulations and seatbelt laws were initially attacked as robbing us of choice; now we know they’re lifesavers.

Thus the most novel and interesting parts of Freudenberg’s book are those that rephrase the discussion of rights and choice, because we need more than seatbelt and antismoking laws, more than a few policies nudging people toward better health. Until now (and, sadly, perhaps well into the future), corporations have been both more nimble and more flush with cash than the public health arms of government. “What we need,” Freudenberg said to me, “is to return to the public sector the right to set health policy and to limit corporations’ freedom to profit at the expense of public health.”

Redefining the argument may help us find strategies that can actually bring about change. The turning point in the tobacco wars was when the question changed from the industry’s — “Do people have the right to smoke?” — to that of public health: “Do people have the right to breathe clean air?” Note that both questions are legitimate, but if you address the first (to which the answer is of course “yes”) without asking the second (to which the answer is of course also “yes”) you miss an opportunity to convert the answer from one that leads to greater industry profits to one that has literally cut smoking rates in half.

Similarly, we need to be asking not “Do junk food companies have the right to market to children?” but “Do children have the right to a healthy diet?” (In Mexico, the second question has been answered positively. Shamefully, we have yet to take that step.) The question is not only, “Do we have a right to bear arms?” but also “Do we have the right to be safe in our streets and schools?” In short, says Freudenberg: “The right to be healthy trumps the right of corporations to promote choices that lead to premature death and preventable illnesses. Protecting public health is a fundamental government responsibility; a decent society should not allow food companies to convince children to buy food that’s bad for them or to encourage a lifetime of unhealthy eating.”

Oddly, these are radical notions. But aren’t they less “un-American” than allowing a company to maximize its return on investment by looking to sell to children or healthy adults in ways that will cause premature mortality? As Freudenberg says, “Shouldn’t science and technology be used to improve human well-being, not to advance business goals that harm health?” Two other questions that can be answered “yes.”

 

By: Mark Bittman, Contributing Op-Ed Writer, The New York Times, February 26, 2014

March 2, 2014 Posted by | Consumers, Public Health | , , , , , , , | Leave a comment

“Rand Paul’s Dangerous Lasik Obsession”: But When It Comes To The Uninsured, Nobody Has A Right To Health Care

Senator Rand Paul has spent much of the August recess engaged in typical political activities—attending a roundtable on school reform, participating in a fundraiser for a fellow Republican, and speaking at a local ham breakfast. But Paul also set aside some time for one more unusual activity: Helping some people to see. Paul, an ophthalmologist, performed several eye surgeries. All of them were for patients who don’t have insurance. And he donated his services for free.

I know what you’re thinking: Paul and his advisers decided to publicize his day of charity care, in order to create the impression that he’s a do-gooder. You’re probably right. I first learned about it from an article by Katrina Trinko of National Review, who was on the scene to write about it. So were some other reporters, including a television crew. They didn’t get there by accident. But who cares? Maybe Paul was looking for good headlines or maybe he was trying to keep up his skills. (Senate rules prohibit him from maintaining a private practice while in office.) Regardless, Paul appears to have a genuine history of charity work: According to his official biography, he helped establish the Southern Kentucky Lions Eye Clinic and has won awards for his humanitarian work. Now, thanks to this latest surgical effort, a handful of people have better sight. Good for them and good for Rand Paul.

Of course, as Trinko’s story makes clear, Paul would have you believe that his good deeds—and his experience as a physician—justify his positions on health care policy. That’s another matter entirely. Paul is a well-known critic of government-run and government-regulated health care programs, starting with the Affordable Care Act. The opposition is in many ways philosophical: Nobody has a “right” to health care, he says, because that would mean people have a right to commandeer the labor of those who provide care. Trinko, in her article, quotes Paul explaining this position during a speaking event:

“As humans, yeah, we do have an obligation to give people water, to give people food, to give people health care,” Paul muses. “But it’s not a right because once you conscript people and say, ‘Oh, it’s a right,’ then really you’re in charge, it’s servitude, you’re in charge of me and I’m supposed to do whatever you tell me to do. . . . It really shouldn’t be seen that way.”

It’s a strange, almost nonsensical argument, for reasons that Paul Waldman notes at the American Prospect:

saying that health care is a right doesn’t mean that doctors have to treat people without being paid, any more than saying that education is a right means that public school teachers have to work for free. Because we all agree that education is a right, we set up a system where every child can be educated, whether their families could afford to pay for it themselves or not. It doesn’t mean that any kid can walk up to a teacher in the street and say, “I command you to teach me trigonometry for free. Be at my house at 9 tomorrow. You must do this, because I have a right to education and that means I am in charge of you and you’re supposed to do whatever I tell you to do.”

Of course, Paul is also making a practical argument. With less government interference and regulation, and more people paying for services directly rather than through insurance, the market would bring down prices on its own—and medical care would become more affordable for everybody. As proof, he points to a procedure ophthalmologists know well: Lasik, the laser eye surgery that eliminates the need for glasses or contact lenses. Via Trinko, again:

“Insurance doesn’t cover Lasik surgery, the surgery to get rid of glasses,” Paul remarks. “So it started at about $2,000 an eye, maybe even $2,500 an eye, and it’s down in some communities to under $500 an eye because competition works and people call on average four doctors to get the price and see how much it’s going to cost.”

Libertarians and conservatives love to cite Lasik. But Lasik tells you almost nothing about the rest of the health care system, for reasons Jeff Levin-Scherz, a physician at the Harvard School of Public Health, has pointed out:

1. Lasik surgery is entirely elective.  No one NEEDS it!

2. Lasik surgery is never an emergency. Hence, it’s much more “shoppable” than most health care

3. Lasik surgery is highly automated—the computers actually do a substantial amount of the work. Therefore quality is more uniform than most health care

4. There is very high fixed cost for the Lasik laser—and the low variable cost makes it more likely that providers will price this at “marginal” cost—leading to large discounts. That’s not true of cognitive services.

Ten extra visits with a neurologists cost almost ten times as much as a single visit given the large variable cost of the neurologist’s labor. Ten extra Lasik surgeries cost only a small amount more than a single surgery—since the cost of the ophthalmologist and technician is a relatively smaller portion of the total cost.

And that’s not to mention the fact that the Lasik market has been prone to more problems than promoters like Paul let on. Paul Ginsburg, the economist and president of the Center for the Study of Health Systems Change, testified about this some years ago:

LASIK has the greatest potential for effective price shopping because it is elective, non-urgent, and consumers can get somewhat useful price information over the telephone. Prices have indeed fallen over time. But consumer protection problems have tarnished this market, with both the Federal Trade Commission and some state attorneys general intervening to curb deceptive advertising and poorly communicated bundling practices. Many of us have seen LASIK advertisements for prices of $299 per eye, but in fact only a tiny proportion of consumers seeking the LASIK procedure meet the clinical qualifications for those prices. Indeed, only 3 percent of LASIK procedures cost less than $1,000 per eye, and the average price is about $2,000.

Mostly, though, the problem with Paul’s position on health care reform is the number of people it leaves out. Like every other Republican who has demanded repeal of Obamacare, he’s never proposed anything that would come close to covering as many people, or providing the same level of protection. On the contrary, he’s proposed radical changes to Medicaid that would almost certainly even higher rates of uninsurance than exist today.

According to Trinko’s article, one of the patients Paul treats is a 55-year-old woman. She says she has no insurance because it would cost her $700 a month—money that she doesn’t have. Under Obamacare, people in her position would be eligible for subsidies worth hundreds or even thousands of dollars a month—or they’d have a chance to enroll in Medicaid, as long as their state officials weren’t refusing to participate Obamacare’s expansion of the program.

Paul helped that woman to see. But if he has his way, millions of Americans in similar situations won’t be as lucky. They won’t have the same access to care or they’ll face financial ruin. Ultimately, what Paul does at a surgical center matters a lot less than what he does at the Capitol—or, potentially, the White House.

 

By: Jonathan Cohn, Senior Editor, The New Republic, August 27, 2013

September 1, 2013 Posted by | Health Care, Uninsured | , , , , , , , | Leave a comment

“Enumerated Powers” And The Radicalism of The GOP Thought Process

Republican presidential hopeful Rick Perry chatted with The Daily Beast yesterday, and was asked about his understanding of “general welfare” under the Constitution. The left, the Texas governor was told, would defend Social Security and Medicare as constitutional under this clause, and asked Perry to explain his own approach. He replied:

“I don’t think our founding fathers, when they were putting the term ‘general welfare’ in there, were thinking about a federally operated program of pensions nor a federally operated program of health care. What they clearly said was that those were issues that the states need to address. Not the federal government. I stand very clear on that. From my perspective, the states could substantially better operate those programs if that’s what those states decided to do.”

It’s worth pausing to appreciate the radicalism of this position. When congressional Republicans, for example, push to end Medicare and replace it with a privatized voucher scheme, they make a fiscal argument — the GOP prefers to push the costs away from the government and onto individuals and families as a way of reducing the deficit.

But Perry is arguing programs like Medicare and Social Security aren’t just too expensive; he’s also saying they shouldn’t exist in the first place because he perceives them as unconstitutional. Indeed, when pressed on what “general welfare” might include if Medicare and Social Security don’t make the cut, the Texas governor literally didn’t say a word.

Now, this far-right extremism may not come as too big a surprise to those familiar with Perry’s worldview. He’s rather obsessed with the 10th Amendment — unless we’re talking about gays or abortion — and George Will recently touted him as a “10th Amendment conservative.” Perry’s radicalism is largely expected.

It’s worth noting, then, that Mitt Romney seems to be in a similar boat. He was asked in last night’s debate about his hard-to-describe approach to health care policy, and the extent to which his state-based law served as a model for the Affordable Care Act. Romney argued:

“There are some similarities between what we did in Massachusetts and what President Obama did, but there are some big differences. And one is, I believe in the 10th Amendment of the Constitution. And that says that powers not specifically granted to the federal government are reserved by the states and the people.”

What I’d really like to know is whether Romney means this, and if so, how much. Because if he’s serious about this interpretation of the law, and he intends to govern under the assumption that powers not specifically granted to the federal government are reserved by the states and the people, then a Romney administration would be every bit as radical as a Perry administration.

After all, the power to extend health care coverage to seniors obviously isn’t a power specifically granted to the federal government, so by Romney’s reasoning, like Perry’s, Medicare shouldn’t exist. Neither should Social Security, the Civil Rights Act, the Clean Air Act, student loans, FEMA, or many other benchmarks of modern American life.

And if Romney doesn’t believe this, and he’s comfortable with Medicare’s constitutionality, maybe he could explain why the federal government has the constitutional authority to bring health care coverage to a 65-year-old American, but not a 64-year-old American.

By: Steve Benen, Contributing Writer, Washington Monthly-Political Animal, August 12, 2011

August 13, 2011 Posted by | Affordable Care Act, Congress, Conservatives, Constitution, Deficits, GOP, Health Reform, Ideologues, Ideology, Medicare, Politics, Republicans, Right Wing, Seniors, Social Security, States, Teaparty | , , , , , , , , , , , , , , | Leave a comment

Medicare Saves Money: Ensuring Health Care At A Cost The Nation Can Afford

Every once in a while a politician comes up with an idea that’s so bad, so wrongheaded, that you’re almost grateful. For really bad ideas can help illustrate the extent to which policy discourse has gone off the rails.

And so it was with Senator Joseph Lieberman’s proposal, released last week, to raise the age for Medicare eligibility from 65 to 67.

Like Republicans who want to end Medicare as we know it and replace it with (grossly inadequate) insurance vouchers, Mr. Lieberman describes his proposal as a way to save Medicare. It wouldn’t actually do that. But more to the point, our goal shouldn’t be to “save Medicare,” whatever that means. It should be to ensure that Americans get the health care they need, at a cost the nation can afford.

And here’s what you need to know: Medicare actually saves money — a lot of money — compared with relying on private insurance companies. And this in turn means that pushing people out of Medicare, in addition to depriving many Americans of needed care, would almost surely end up increasing total health care costs.

The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.

But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.

By the way, we have direct evidence about the higher costs of private insurance via the Medicare Advantage program, which allows Medicare beneficiaries to get their coverage through the private sector. This was supposed to save money; in fact, the program costs taxpayers substantially more per beneficiary than traditional Medicare.

And then there’s the international evidence. The United States has the most privatized health care system in the advanced world; it also has, by far, the most expensive care, without gaining any clear advantage in quality for all that spending. Health is one area in which the public sector consistently does a better job than the private sector at controlling costs.

Indeed, as the economist (and former Reagan adviser) Bruce Bartlett points out, high U.S. private spending on health care, compared with spending in other advanced countries, just about wipes out any benefit we might receive from our relatively low tax burden. So where’s the gain from pushing seniors out of an admittedly expensive system, Medicare, into even more expensive private health insurance?

Wait, it gets worse. Not every 65- or 66-year-old denied Medicare would be able to get private coverage — in fact, many would find themselves uninsured. So what would these seniors do?

Well, as the health economists Austin Frakt and Aaron Carroll document, right now Americans in their early 60s without health insurance routinely delay needed care, only to become very expensive Medicare recipients once they reach 65. This pattern would be even stronger and more destructive if Medicare eligibility were delayed. As a result, Mr. Frakt and Mr. Carroll suggest, Medicare spending might actually go up, not down, under Mr. Lieberman’s proposal.

O.K., the obvious question: If Medicare is so much better than private insurance, why didn’t the Affordable Care Act simply extend Medicare to cover everyone? The answer, of course, was interest-group politics: realistically, given the insurance industry’s power, Medicare for all wasn’t going to pass, so advocates of universal coverage, myself included, were willing to settle for half a loaf. But the fact that it seemed politically necessary to accept a second-best solution for younger Americans is no reason to start dismantling the superior system we already have for those 65 and over.

Now, none of what I have said should be taken as a reason to be complacent about rising health care costs. Both Medicare and private insurance will be unsustainable unless there are major cost-control efforts — the kind of efforts that are actually in the Affordable Care Act, and which Republicans demagogued with cries of “death panels.”

The point, however, is that privatizing health insurance for seniors, which is what Mr. Lieberman is in effect proposing — and which is the essence of the G.O.P. plan — hurts rather than helps the cause of cost control. If we really want to hold down costs, we should be seeking to offer Medicare-type programs to as many Americans as possible.

By: Paul Krugman, Op-Ed Columnist, The New York Times, June 12, 2011

June 13, 2011 Posted by | Affordable Care Act, Congress, Conservatives, Consumers, Economy, GOP, Government, Health Care, Health Care Costs, Health Reform, Ideologues, Ideology, Insurance Companies, Lawmakers, Medicare, Politics, Public Health, Republicans, Right Wing, Seniors, Single Payer, Under Insured, Uninsured | , , , , , , , , , , , , , | 1 Comment

GOP Supported Individual Mandate To Prevent ‘Government Takeover’ Of Health Care

The Los Angeles Times’ Noam Levey looks at the history of the individual health insurance mandate and discovers that not only was the provision designed by Republicans as an alternative to President Bill Clinton’s health care reform plan in the 1990s, but it was specifically seen as a way to prevent a “government takeover” of health care:

“We were thinking, if you wanted to achieve universal coverage, what was the way to do it if you didn’t do single payer?” said Paul Feldstein, a health economist at UC Irvine, who co-wrote the 1991 plan with Pauly.

Feldstein and Pauly compared mandatory health insurance to requirements to pay for Social Security, auto insurance, or workers’ compensation.

So too did the Heritage Foundation’s Stuart Butler, who in 1989 wrote a health plan that also included an insurance requirement.

“If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate, but society feels no obligation to repair his car,” Butler told a Tennessee health conference that year.

But healthcare is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance.… A mandate on individuals recognizes this implicit contract,” said Butler, who was the foundation’s director of domestic policy studies.

Levey notes that fully a third of Republicans supported a bill that included a national individual requirement, introduced by then-Senator and current Rhode Island Gov. Lincoln Chafee. Sens. Bob Dole (R-KS), Charles Grassley (R-IA), Orrin Hatch (R-UT), and Richard Lugar (R-IN) all backed that measure. The National Federation of Independent Business, a conservative small-business group, even “praised the bill ‘for its emphasis on individual responsibility.’”

And this wasn’t some fluke of the ’90s either. As recently as 2007, “[t]en Republican senators — including Tennessee’s Lamar Alexander, now a GOP leader — signed on to a bill that year by Bennett and Sen. Ron Wyden (D-Ore.) to achieve universal health coverage.” The legislation penalized individuals who did not purchase insurance coverage.

Listing all of the GOP presidential candidates who have previously supported the mandate (Romney, Gingrich, Huntsman, Pawlenty) would only belabor the point, which is that the GOP’s new-found religion on the mandate and its constitutionality is driven by the political need to unravel the Democrats’ crowning social achievement, not any great concerns about policy, constitutionality, or freedom.

 

By: Igor Volsky, Think Progress, May 31, 2011

June 1, 2011 Posted by | Businesses, Class Warfare, Conservatives, Constitution, Democracy, Democrats, Freedom, GOP, Government, Health Care, Health Reform, Human Rights, Ideologues, Ideology, Individual Mandate, Insurance Companies, Lawmakers, Liberty, Middle Class, Politics, Public Option, Republicans, Right Wing, Single Payer | , , , , , , , , , , , , , , | Leave a comment

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