Year: 2011

A study by a professor of emergency medicine at the University of Pennsylvania released this morning shows that children on Medicaid are denied care more and have to wait much longer for appointments than other children. 

The details of the study are stunning: Two-thirds of children whose parents mentioned they were on Medicaid were denied appointments, compared to only 11% of children whose parents did not mention Medicaid.  For those clinics that accepted both kinds of patients, callers who said their kids were Medicaid had to wait an average of 22 days longer for an appointment than those who didn’t mention receiving Medicaid.  The study covered Cook County, Illinois, an enormous metropolitan region that includes Chicago and many suburbs.

These despicable figures follow reports featured in a USA TODAY story a year ago that documented the growing number of physicians who don’t accept Medicare patients:

• The American Academy of Family Physicians reported that 13% of family physicians didn’t participate in Medicare in 2009, up from 6% five years earlier.
• The American Medical Association said 17% of all doctors and 31% of primary care physicians they surveyed limit their Medicare patients.

These physicians who turn away the poor because they won’t get paid as much money to treat them are truly hypocrites, because they all took some form of the traditional Hippocratic oath, named after a Greek physician known as the father of medicine.  Wikipedia’s version of the classic English version of the Hippocratic oath includes this paragraph:

“I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.”

And here’s a line from the widely used modern version: “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

No one is asking these doctors who turn away Medicare and Medicaid patients to treat them for free.  We ask that they treat the elderly and the poor at a reduced fee. 

U.S. physicians earn a whole lot more money than their peers in every other country in the world.  It’s open to debate whether or not our doctors are better practitioners and therefore deserving of all money.  But consider this: comparative mortality charts suggest that doctors in many other countries achieve superior results to our physicians. 

Let’s not even argue the quality point because it doesn’t matter in the discussion of why American physicians make more than their global peers.  The American doctors live in the only advanced economy that follows the free-market healthcare model.  Their bigger bucks stem from the luck of the draw.  American physicians not only make more than their global peers, they also make more than virtually any of their patients, that is except for docs who cater to what they used to call the carriage trade.

We constrain free markets all the time, with regulations, tax policy and other market incentives and disincentives.  I’m therefore going to propose a new constraint: as a requirement of keeping the right to practice medicine the percentage of all patients that the doctor treats who are Medicare/Medicaid patients must be a minimum of 85% what it is for the Metropolitan Statistical Area where he/she has offices.  For example, if 15% of all patients in the area are on Medicare and Medicaid, then 12.75% of every physician’s patients must be enrolled in Medicare or Medicaid. Physicians going below 85% would automatically lose their medical licenses for a period of three years. 

The costs for this program would be minimal. With modern digital technology and the rapid implementation of electronic medical records in all physician offices, filing an annual report should be quite simple.  Of course, there would also have to be a small increase in the bureaucracy to audit reports and do spot investigations.  My guess is that this new regulations will lead to a decrease in Medicare/Medicaid costs over time, because adding new participants to a free market always reduces overall costs.  It’s an axiom of capitalist economics!

I would think that those thousands of ethical women and men comprising the majority of physicians would wholeheartedly support this new regulation, as it will level the playing field and take from them some of the burden of caring for patients for reduced fees.    

If a Jewish nonfiction writer sticks around long enough, he or she will be tempted to use the shop-worn “define chutzpah” rhetorical device, which consists of defining chutzpah and then applying the term to the acts or statements of someone or some group, or in simply saying that someone embodies the definition of chutzpah.

Alas, the likes of Representative Anthony Weiner, the U.S. Senate and Jena Troutman have driven your humble OpEdge scribe to resort to this hackneyed literary trope.

Merriam-Webster defines chutzpah as extreme confidence or gall.  While it is true that people with chutzpah usually project self-confidence, the essence of what constitutes chutzpah is an audacity that approaches shamelessness and also has the hint of the comic.  My favorite definition of chutzpah is the man who kills both his parents and then throws himself on the mercy of the court because he’s an orphan.    

Thus it took chutzpah for Mitt Romney to condemn the federal health care law that mimics the Massachusetts healthcare law he shepherded through the state legislature.  And it took chutzpah for the creators of our torture system to say that torture helped to find bin Laden.

But this past week we have seen at least three poster children for chutzpah emerge.

Isn’t it the height of chutzpah for Representative Weiner not to resign?  I don’t care that he showed his stuff online and I don’t care that by doing so he may have betrayed his new wife; those are personal issues.  But to lie when the digital age makes it so easy for the truth to come out either shows appalling ignorance or sheer stupidity, neither of which you want in a Congressional representative. Then there’s the matter of the evidence, which suggests that in more than one instance, his photographic transmissions were unsolicited, out of the blue and completely out of context, raising them from the harmless to potentially harmful harassment, and therefore a cause for resignation.

Of course, in the old days, my great uncles and aunts would have likely engaged in a heated shout-out over tea as to whether Weiner was a schmuck or a putz (two Yiddish words that originally meant a male’s “wiener,” but have long referred to categories of fools).

And isn’t it the height of chutzpah for 56 U.S. Senators to vote to postpone the date when the debit card reforms go into effect?  This vote favored banks, while ignoring the best interests of both consumers and small businesses (which make up more than 98% of all employers, according to the Small Business Administration).  These Senators will now go home and shamelessly and audaciously tell the voters that they are acting in their best interests.  Now that’s chutzpah!  Luckily, the motion needed 60 Senators to approve it, so it failed.

And doesn’t it take chutzpah for Jena Troutman, organizer of the ban circumcision movement in California, to claim that her petition was “never about religion,” when the head of the group that wrote the ballot proposal for her has created a cartoon character named Foreskin Man who fights the evil “Mohel Man.” Mohel, for the uninitiated, is the Hebrew word for the religious specialist who cuts the foreskin during the circumcision rite.  Thank goodness for another small wonder: Troutman is ending her pursuit of this anti-Semitic, anti-Moslem ballot initiative.

Shameless audacity—chutzpah—seems to define the current political tone in this country. 

But let’s not include Tim Pawlenty, former Minnesota Governor and Republican candidate for President, among the “chutzpahim.” 

Yes, it takes chutzpah for Pawlenty to say that by drastically cutting taxes and ending most non-military government spending, he can grow the economy by 5% within a few years and not tell us or show us how.  But in giving his plan to renew the U.S. economy, Pawlenty proposed a “Google” test for government: if you can Google it, the government shouldn’t be providing it.  Pawlenty forgets that the Internet was created as a government project called ARPANET and that without government support, there would be no Google, or any other Internet-based company, because there would be no Internet.  That makes Pawlenty a schmuck or a putz, reader’s choice.

The news that Palinistas, followers of Sarah Palin, tried to rewrite the history of the American Revolutionary War on Wikipedia shouldn’t surprise anyone who has been following the news media for the past few years.  Right-wingers, with a helpful assist from the mainstream news media, have had a lot of success revising our reading of contemporary history.  Luckily, they did not have such an easy time of it trying to rewrite the history of the American Revolution.

It all started when Miss Sarah, who doesn’t seem to ever care about a word’s worth, claimed that when Paul Revere took his famous ride, he was warning the British that they better not try to take away our guns.  Anyone who remembers elementary, middle school and/or high school history will LOL, scratch their heads quizzically, or maybe just let out a blood-curdling scream of frustration.  As we all learn multiple times in school as part of the one-page version of our national history, Revere was warning American patriots that the British armed forces were on the move.  Like an equestrian version of a phone tree, Revere warned others who then warned others. 

A few days later, Palin embarrassed herself by saying that she got her history right.  No one believed her. The mainstream news media, political cartoonists and late-night comics mocked her.  Another amusing sideshow.

Any public relations professional with a few years experience could have told Miss Sarah that she should have apologized and said that she made a mistake in the excitement of the moment, that she knew, of course, that Paul Revere warned his fellow revolutionaries that the British regular armed forces were moving their way.

Then came the discovery by the website LittleGreenFootballs.com that the Palinistas were trying, unsuccessfully thank goodness, to edit the Wikipedia article on Paul Revere to match what Palin had said.  Little Green Footballs even supplied us with a link to the history of recent Wikipedia revisions of the Paul Revere article.

The result has been yet another wave of ridicule heaped upon Miss Sarah’s grizzled shoulders. 

For most of us, who learn always to play by the rules, it seems unredeemably despicable that anyone—let alone a group of people—would try to change history on Wikipedia. How could they stoop so low?

But let’s face it.  Right-wingers try to rewrite history all the time.  Here are recent examples, most of which were quite successful, of the right-wing rewriting history:

• As National Public Radio mentioned yesterday morning, 10 years ago to the week the temporary Bush II tax cuts were passed and we had a budget surplus.  Now we face an enormous deficit, which the right-wing, with the help of the mainstream news media, loudly blames on spending too much on programs that help the hungry, poor, elderly, young and disabled and job-creating programs that modernize our crumbling infrastructure of roads, bridges and mass transit.   The real history is that the people, and especially the wealthy, have not been paying enough in taxes.
• In the last election, the total number of people who attended national rallies by progressives was roughly twice those attending the Glen Beck rally.  Yet right-wingers have written the history of the election season that has been accepted by mainstream and even liberal voices.  That false narrative has many more people attending the Glen Beck rally, which served as the high point of the Tea Party surge, which was another “Potemkin Village” perpetrated on Americans by the mass media. 
• Slightly less successful were the efforts of the Bush II Administration to revise the rationale for the Iraq War as a democracy-building exercise once their original lies about weapons of mass destruction and connections to Al Qaeda proved false.  The mainstream news media quietly slid into supporting this view, and nowadays news media coverage focuses on milestones of Iraqi democracy and corresponding troop withdrawals.  But many people still remember the lies.
• Rich poor right-wing blogger Andrew Breitbart created history when he cut away most of what Shirley Sherrod was saying and turned a boring reasoned speech into a scandal of “black racism,” which most of America fell for, at least until someone decided to do a little fact-checking.
• We don’t know if it will be successful yet, but the right-wing continues to shout the canard that torture was instrumental in locating Osama bin Laden.  All the evidence says otherwise, but that usually doesn’t stop the right wing.

So we know that these guys live by a different set of ethics than most of us.  They believe that the end really does justify the means.  They don’t care about our free marketplace of ideas, only for moving the country towards their ideas.

Where did the Palinistas go wrong in this absurd scandal?  It was in their arrogance and stupidity to think that they could turn the country’s opinion about one of the very basic facts drummed into our heads from an early age.  It’s the old tabula rasa idea, first discussed by Aristotle. The tabula rasa is a blank slate.  That’s what we are when we first hear about anything, be it a new idea or a new product.  So the first thing we hear shapes our view of what comes next. That’s why it’s easier to establish an opinion than to change one and why it’s easier to link a new product to a message than to change the message you want to link to an existing product.   There is no existing impression with current events, so it’s easy to turn people’s view on what is happening or just happened.

Not so easy with our shared history. People know and love the Romantic product called Paul Revere’s ride.  He bravely rode off into the night warning our forefathers and foremothers—all dedicated to democracy and self rule—that the British regular armed forces were coming.  How adventurous, brave, cunning and virtuous!  So it is taught in read-to books for toddlers, and in every American history course through high school.  No one is going to believe it when you tell them he was really warning the British.  And when you say that the warning was “don’t attempt gun control,” then most people will break out in crooked-mouth snickers that say “Gimme a break!” 

The Palinistas overreached, and we’ve all had a good laugh.  But let’s not forget that they and their Tea-publican fellow travelers are trying to rewrite history all the time to justify their radical views.

While still small, the movement to ban circumcision seems to be growing in California.  A few weeks ago I read that a petition drive had yielded enough signatures to get banning circumcision of newborn males on the ballot in San Francisco.  Now a similar petition effort is underway in Santa Monica. 

There is little likelihood these or other measures would pass, and even if they did, they wouldn’t hold water in court.  But still, it does give one pause, at least if one is Jewish like me, or Moslem, like many of my friends.

I visited wholebabyrevolution.com, run by Jena Troutman, the woman who is leading the ban circumcision movement in California.   It repackages its litany against circumcision in several ways, in a “25 reasons” list, an FAQ and several articles.   It all comes down to three messages:

1. It is medically unnecessary
2. It has medical risks
3. It has lifelong side effects, the most dramatic of which is decreased erotic sensitivity in that area.

Reasons number two and number three are patently false, disproved by lots of research, and in the case of decreased sensitivity, a whole lot of anecdotal evidence as well.  As to the lack of medical necessity: many studies have shown through the years that women with circumcised partners have lower rates of uterine cancer and that circumcised males are far less likely to contract certain bacterial diseases in that area.  As a feisty aunt of mine might say, if it doesn’t hurt and it might help, what’s the problem?

Now that I’ve demolished the arguments of the ban circumcision movement, I want to speculate about its origins, to wit, is it a veiled attack on Jews and/or Moslems (since many Moslems also circumcise new-born males)?  I saw not a note of anti-Semitic or anti-Moslem ideas on either the website or any of the dozens of medically-themed articles against circumcision you can find at wholebabyrevolution.com.  (The impressive list reminds me of the equally impressive lists of articles I used to see on the health benefits of gingko biloba and laetrile.)

Despite the hygienic approach of the materials and the campaign, I assert that based on the given information, any act to ban circumcision is inherently and irrefutably anti-Semitic and anti-Moslem.  We may never know, but it’s difficult not to wonder if behind the smiley and earnest dedication of Jena Troutman lurks some money that hates Jews, and may hate Moslems, too.

I think Jews should learn a lesson from the small ban circumcision movement, a lesson that I believe many enlightened Moslems have known for some time: that there are more communalities between the Jewish and Moslem religions and cultures than there are between either of these venerable civilizations and Christianity.  Think of ancient language, dietary restrictions, multiple daily prayer times, prayer repetition, professions in Diaspora, musical traditions, methodologies of its great philosophers—the list of points at which Jewish and Moslem culture touch are endless.

American Jews should contemplate these similarities when asked to join forces with the American religious right in the kind of holy war proposed by the likes of Professor Samuel P. Huntington of the “clash of civilizations” theory.  And Israelis might remember these similarities when they consider the civil and economic rights of Palestinians and when they contemplate the possibility of negotiating peace in the Middle East.

In his regular column on the Op/Ed page of last Saturday’s New York Times, Charles Blow presented survey results from the Pew Research Center in chart form without explanation.  His article, titled “False Choices,” is loosely related to the chart and proposes that “we need both sensible tax increases and sensible spending cuts to address the deficit.”  I generally like what Blow has to say, but I reject this assertion, for two reasons: 1) The deficit should not be an issue until we have more people working; 2) Tax increases, and not cuts to job-creating programs, should be the only way to cure the deficit problem because taxes are currently too low on higher incomes; additionally, raising taxes always produces jobs.  Of course, maybe by “sensible cuts,” Blow means cuts to military spending, which I enthusiastically support.  Alas, Blow is not specific.

But I don’t want to quibble with Blow, but instead shed some light on the Pew study he presents. I want to do the math for everyone who saw, or didn’t see, the article, and extrapolate from it a phenomenon that truly is frightening: Americans acting and voting against their own best interest.

The results of the Pew study of a representative cross-section of adults nationwide show that while 53% of those surveyed are following the debate on raising the U.S. debt ceiling very closely or somewhat closely, only about 48% believe they understand what would happen if the debt ceiling is not raised. 

Despite their uneasiness with the subject, an incredible 73% of those surveyed are very concerned or somewhat concerned that not raising the debt limit would force the United States to default and hurt the nation’s economy. The Pew study thus shows that Americans are well aware that it’s a very bad idea not to raise the debt ceiling.

And yet when asked if they wanted their Congressional representative to vote in favor of or against raising the debt ceiling, only 19% said in favor, while 47% said to vote against. (34% said they didn’t know enough to have an opinion.)

So once again, Americans seem to be voting against their own best interests.  They realize that raising the debt ceiling is a necessity, and yet they want their Congressperson to vote against it.  

What is going on here?  Last week, I told you about a group (too small to be statistically representative) whose incomes depend to a large extent on the government doling out money to nonprofit organizations, yet nevertheless are against tax increases that for the most part wouldn’t harm them.

Eight months ago, I noted that working class whites are supporting the very political party—the Republicans—that has been taking money from the working class since Ronald Reagan assumed the presidency.  

I understand that about a quarter to a third of the voters put more stock in social issues than economic or political issues; really I should say “social control” issues, because in all cases, these so-called “values” voters want to control what other people do, e.g., by opposing gay marriage and a woman’s right to have an abortion or by inserting Christianity into public and secular places.  Related to, and to a large extent overlapping, these “social control” voters are those who vote on the single issue of gun rights.  Whether they know it or not, except for the ultra-wealthy among them, these groups of voters have made a devil’s bargain with the economic free-marketers: support our values and we’ll support your economic policies even though they hurt us.

Of course that doesn’t explain the rest of those voting against their own interests.

Yesterday the Associated Press released the latest version of its surveys with GfK and it shows that two-thirds of the public say that Social Security or Medicare benefits can’t be cut because they are vital to their financial security as they age.

Hey, let’s face it.  One reason that Americans can spend so much in good times, and thereby serve as Atlas holding up the world’s economy, is that they depend on Social Security and Medicare to take care of a good part of their needs when retired or infirm.

More facts from the survey: 70% said Social Security is “extremely” or “very” important to their financial security in retirement, and 72 percent said so for Medicare.

The story points out that 54 percent believe it’s possible to balance the budget without cutting spending for Medicare, and 59 percent say the same about Social Security.

But the Associated Press does its best to spin the story away from the message the voters are emphatically communicating to elected officials: find another way to balance the budget than taking it away from the elderly.  Instead the article becomes a quiet little hand-wring that the experts have not been able to convince people to sacrifice their retirement benefits, even though the rich are currently paying an historically small share of total taxes.

First and foremost, like every other story I have ever read about the future of Social Security and Medicare, the writer focuses on the short-term and not the long-term.  Check out this statement: “Combined, Social Security and Medicare account for about a third of government spending, a share that will only grow.” True enough, but then the baby boomers will all die and the next generation of seniors will be much smaller, so Social Security and Medicare will not have the current problem it faces: not enough working people to support the growing number of retirees.

Demographers have likened the journey of the baby boomers through life to a rat passing through the snake that has just swallowed it: to the observer, a bulge is moving through the snake, from head to tail.  Because the population of boomers is so much larger than the one that came before it and was followed by a baby bust, wherever the boomers have been in their life cycle, its bulge has created both challenges for society and opportunities for businesses.  

Now we boomers are old, and that means there are more old people than ever before in history.  The very good news is that they’re living longer, which of course means we have the responsibility of paying for their Social Security and Medicare longer.  In a humane society, that should be a problem we all like to have, like the problem of having to pay for a child to go to Stanford or North Carolina-Chapel Hill.

Every expert the AP story quotes says that we will have to cut benefits, and these opinions are underscored by statements such as, “Again, there’s a sharp difference between what the public believes and what experts say. Most experts say the programs will be there for generations to come. But they may look very different than they do today, and Americans should take note.”

No one in the article mentions raising taxes, nor does the reporter.  For some reason raising taxes is completely off the table.  And yet we could solve the temporary challenge presented by the baby boom bulge as simply as lifting the limit on income that is assessed the Social Security and Medicare taxes.

I’d like to see AP-GfK ask people if they would be willing to have higher taxes on the wealthy to keep Social Security and Medicare solvent while my rat of a generation completes its journey through the snake of life.  My guess is that Americans would be overwhelmingly in favor of it.  

Yesterday morning I entered the following search terms into Google News: “budget cuts school district.”  I didn’t stop perusing the articles until I got through 40 of the more than 7,000 listed, and the articles were still dated May 21 and May 20 (the two prior days).  I skipped ahead to the 120th article and we were still on May 18 (less than a week ago).

The 40 stories over a two-day period to which I linked came from all over the country, including South Berkeley, Michigan;  Great Falls, Montana; Iowa City, Pennsylvania; Levittown, Pennyslvania; Logan, Utah, the Meridian School District in Idaho;  the Plymouth School District in Sheboygan, Wisconsin; and the Pendleton School District in Oregon.

Most of the articles bemoaned the fact that state and federal budget cuts were leading to teacher and support staff layoffs and the curtailing of programs.  Of special note are these shockers:

• Philadelphia intend to close schools for at-risk students.
• Many Illinois schools districts are cutting pre-school programs, which have been proven to improve the performance of students in later years.
• Two PA school districts are considering cutting to four days a week (from a  story a few weeks back I remembered)

While there are a handful of stories about districts raising taxes (usually the millage on property taxes) or doing fundraising, the tone of virtually all the stories favored defeatist and discouraged hand-wringing.  School boards, parents and teachers seem to accept their fate in an oddly disoriented, almost catatonic way. We’ve seen some anger, but not as much as I think there should be among either parents or school districts. 

In fact, I think we should be seeing people everywhere up in arms!

The anger should be directed at our politicians for preferring the interest of one group of Americans above all others: the wealthy.

Board members tend to be smart, educated and media savvy.  They must know these well-documented facts:

• If Americans, and in particular the wealthy, paid in taxes today what they did 30 years ago, we wouldn’t have the tax shortages that are forcing these terrible cut-backs, which will hurt children, and in particular children in the poorest school districts.
• The recently negotiated budget cuts are paying for the two-year extension of the temporary tax breaks for those making more than $250,000 per year.
• While many Americans bemoan the many “failures” of education in this country, an overwhelming majority think their own children are getting or had a fine education in their public schools.

These facts form the basis for action by school boards and calls to action to residents of the school district.

I want to recommend the following actions to school board members. Some provide immediate funds to staunch the bleeding, while others can help to build towards a more permanent financing solution. 

1. Immediately raise school taxes, even if it’s a temporary move.

Most school districts have taxing authority, often over real estate.  The rationale for increasing the millage or other taxes is straight-forward: Everyone is paying less than they should in federal taxes now and we need this money to educate our children.  To make the tax increase fair, school districts could consider a number of ideas: in many school districts it might be possible to exempt retired people with houses under a certain value from the additional amounts or to add a tier of additional taxes on those properties worth more than a certain value.

Raising taxes in the current environment will take a lot of courage.  In many school districts, there are sure to be recall campaigns, financed by those who have abdicated their responsibility for educating all our children in return for a few, or many, pieces of silver.  But I would hope that voters whose children’s lives are improved by the increased millage will offset the “taxes are always too high” bunch. 

2. Close down all charter schools that do not perform better than the public school.

That will mean closing down most charter schools, since all studies show that most charter schools underperform both in the classroom and on standardized tests. Charter schools take money from public schools, much of which is turned into profit for the charter school operator.  By returning charter school students to the public school classrooms, the public schools can put this “profit” back to work to educate children.

3. Make sure the voters know whose fault it is.

School boards (perhaps jointly with teachers unions) should send to all voters a monthly update of the following lists:

• State and federal legislators and announced candidates who have voted to cut education or proposed such cuts.
• State and federal legislators and announced candidates who are voting to cut taxes or to continue temporary tax cuts or who support such moves.

People need to know just who it is who continues to transfer wealth from the poor and the middle class up the ladder to the wealthy by extending a three-decades-old low-tax regime while demanding draconian cuts to education (and to alternative energy, infrastructure improvements, the elderly and health care).

Most school districts have a public relations budget.  I recommend that over the short term, most of it be dedicated to a campaign that communicates one message: “We need to raise federal income taxes to support the education of our children.”

The last election saw right-wingers who want to lower taxes more and cut funds for public education sweep into office, but they didn’t win because an overwhelming majority of Americans agree with their views.  They won because their voters went to the polls and those who would prefer a more equitable distribution of the wealth in the United States stayed home. 

The right-wingers were, of course, aided in the last election by the mainstream news media, which consistently framed issues in conservative terms, gave far more coverage to Republican candidates and events and kept hidden key facts that might have energized Democratic, young and minority voters to come to the polls. But school districts can speak directly to voters, with notes to parents, the monthly newsletter, the district website and school meetings.  Moreover, school districts are too big to ignore in the local news media.  School districts can build a let’s raise taxes to where they once were so we can educate our children message into everything they send the media, from the announcement of how the kids did on standardized tests to the cute feature on careers day.

It’s time for school boards to take a stand in favor of the constituency they are supposed to represent: the youth of America (as Casey Stengel used to say).  Those who say that the school boards in fact represent the entire community have said the same thing because the school board’s charge from the community is to ensure quality and cost-effective education.  It is the fervent and ethical pursuit of that mission that school boards owe to their communities.  The special interest group that school boards represent are not those who want a low-tax regime or selfish, but the children in the district.  That representation demands that school boards take a stand today for higher taxes.