Canada, they hardly know ye
Topic: economy
As soon as I saw Dr. Peter Mott's April 12 D&C op-ed on single-payer health insurance, I knew some MD out there would lob a grenade, live or otherwise.

And sure enough, just five days later, a dud from a Brighton MD landed on the D&C letters page. The doc warned against a Canadian-style single-payer plan, which he claimed "lacks the capacity to provide needed care in a timely manner." He played a slight variation on the orthodox tune: Canadians flock to US hospitals to get care they're denied at home because of long queues and sparse equipment - a situation Americans would never tolerate.

But then the doc tipped his hand.

Shockingly, he suggested that "the solutions to our problems lie in reaching agreement [about] whether we value committing scarce resources to extending the lives of our extreme elderly and those with chronic diseases."

Whoa. And ouch. I thought we had a durable agreement to give care as needed to prolong life and ease suffering. Or at least we held up something like this as an ideal. But was this doctor actually arguing for a form of human sacrifice? Did he mean to endorse a regime of cost-driven triage that would throw the oldest people (age cutoff presumably to be determined by accountants) in the dumpster, and push the chronically ill to the margins?

I hope the argument was nothing more than a D&C editing error, or someone letting his words get away from him. But let's get real: The sort of triage the letter implicitly supported is already common practice. And this might explain in part why the US has such dismal health stats - much worse than Canada's, no matter what the orthodox professionals here would have you believe.

Compare some figures drawn from World Health Organization data bases:

Infant mortality ratio: Canada, 5.1 per 1,000 live births; US, 7.2

Maternal mortality ratio: Canada, 5 per 100,000 live births; US, 14

HIV prevalence, 15-to-49 year olds: Canada, 0.3 percent; US, 0.6 percent

Life expectancy at birth, total pop.: Canada, 80 years; US, 77 years
--- males: Canada, 78 years; US, 75 years
--- females: Canada, 82 years; US, 80 years

Healthy life expectancy at birth. total pop.: Canada, 72 years; US, 69.3 years

Per capita Gross National Income (US dollars): Canada, $23,930; US, $37,600

Per capita health spending (US dollars): Canada, $2,222; US, $5,274

Looking at any or all of these figures, you can't help but conclude the Canadians, who on average aren't as rich as Americans, are doing it better and smarter.

Our neighbors across the lake aren't blind to their
system's shortcomings, either. Recently, the Council of Canadians published an update on health care that acknowledges some problems with their national single-payer system but also - contrary to the practice of stateside critics - shows where the true remedies are to be found. On the matter of queues (wait-times), the Council laid major blame on "a serious shortage of health care providers," and in turn, on health-care funding shortfalls that will require tens of billions in new spending.

In short, the Canadian single-payer system is flawed only to the extent it has been starved of money. As you can see from the WHO figures above, Canada spends half of what the US spends on health per person. If its annual expenditure per capita went up significantly, Canada could easily fix the problems dogging its health system - problems which in any case don't prevent superior national health outcomes.

The bottom line for the US is this: If we went single-payer, we could spend much less per capita and get a lot more health for our buck. And we wouldn't have to set the old folks out on the ice floe.

We're all Parisians now
Topic: economy
During the run-up to the Iraq invasion, the French took a beating from chickenhawk conservatives and big-business liberals alike.

The rants took this basic form: How dare those foreigners contradict our great and wise leaders (here I refer not to George Bush or Dick Cheney – that would be stretching the joke past the breaking point – but to Colin Powell and others who supposedly had “credibility” and basic moral instincts)? Why can’t they be team players? They’re so mysterious; it must be some cultural quirk, an ingrained stubbornness, a pious exceptionalism. Surely there can’t be actual reasons for such contrary behavior.

Now the chick-cons and bb-libs are at it again. But this time the object of their cluelessness is the inspiringly unending series of French rank-and-file protests against the “CPE,” the odious measure that would take away basic job protections from younger workers.

Again, our clueless classes blame it all on French idiosyncrasy. But as even some of the domestic business press is saying, it’s clear the French are struggling against something all too real and threatening – the imposition of American-style labor rules, like the “work at will” regime that condemns working people of all ages to the kind of social insecurity that many Europeans rejected decades ago.

The protesters deserve our support. They understand that their government, carrying water for capital, has its eyes on a further prize: the incremental “casualization” of labor, to be sold over the coming years as one after another adjustment to achieve “competitiveness.” Which, of course, is better known as “the race to the bottom.”

It’s no exaggeration to say the protesters in Paris and elsewhere across France are acting on American workers’ behalf. If Chirac and de Villepin carry the day – at the moment they’re flogging a softer version of the CPE, but the people in the streets aren’t taking the bait – the American labor movement will suffer a real setback. We’ve got enough on our hands already, not only with the massive loss of jobs (cf. GM/Delphi and many others) but with the relentless attacks on labor organizing, again even by those posing as “liberals.”

Maybe justice will prevail and the CPE and the government that floated it will fall. Then we can hope – and work actively – for a westward domino effect.

At war with ourselves
Topic: economy
The Republican right wing’s economic promises long ago became tangible threats, even to its geographical base. I’m sure plenty of Louisianans in the lowland suburbs woke up to this fact even before George Bush slighted them in his State of the Union last week. Everyone an entrepreneur, says Bush. That means you’re ultimately responsible for digging yourself out of the muck, and never mind reconstruction of the levees and floodwalls. New Orleans and Fallujah: two faces of compassionate conservatism in action.

And now comes the president’s budget proposal, with severe cuts in domestic spending across the board, except for defense of the Fatherland, I mean Homeland Security. The Washington Post reports Bush wants to slash Medicare funding by $36 billion over the next five years. He’d also take the axe to Medicaid. Overall, says the Post, 141 programs would be eliminated or cut back. Over at the Pentagon, of course, things would be rosier. Bush proposes a five percent increase in military spending, up to $439 billion, a new world record. That’s not counting tens of billions for the criminal wars in Afghanistan and Iraq.

The full obscenity of this is not being reported, however. The War Resisters League calculated that last year the nation spent $643 billion directly on the military – the sum of the Pentagon budget, military-related parts of such agencies as NASA and the Department of Energy, and the off-budget outlays for Afghanistan and Iraq. And as WRL says, for a fair accounting, add another $384 billion for the fraction of the national debt attributable to past wars. So that comes to more than $1 trillion for “defense” in just one year.

Meanwhile on the home front, where Monroe County and Rochester both face huge budget deficits the next couple of years and federal cuts in revenue-sharing already are being felt, what are politicians asking for, Democrats prominently included? Local leaders are toying with a plan to spend $300 million, much of it from federal transportation funds, for a rapidly metastasizing complex of structures downtown: a combo bus terminal, college campus, and performance center at Main and Clinton, plus a couple more performance halls just to the east.

Maybe they’ll call it Renaissance Squared, a bad idea that seems to grow exponentially – and again the R word seems appropriate, evoking the urban policies of, say, 16th-century bourgeois who lived large while sharing just enough with their slum-dwellers to prevent revolution. (Luckily, the servant class didn’t always cooperate.)

Why aren’t the locals protesting what’s happening in Washington? Why do they keep pretending that “all politics is local”? Why aren’t they drafting realistic strategies to deal with the urban landscape, starting with a Northeast inter-urban collaborative to force change in Washington?

If Rochester saves itself, it won’t be by going it alone, and certainly not by building redundant arts complexes. Check out a recent AP story the Buffalo News carried on the front page. With the suitably Dickensian (though clich?d) headline “A Tale of Two Cities,” the article told the story of Detroit as it welcomed this year’s Super Bowl. Detroit is Rochester writ larger and lower - the world’s premier blue-collar metropolis now depopulated (down to 900,000 from a height of 2 million) and depressed, except for its grand downtown architecture, an off-color Emerald City of casinos and stadiums.

Poor Detroit. Poor Buffalo. Poor us. It’s enough to make you mix some oil-and-water historical allusions. “I have seen the future, and it works [for a few].” And “After me, the deluge.”

But enough pouting. Some day you'll see me in the ticket line for the inevitable road-show production of Les Miserables – at spanking new Renaissance Square. Can't wait.

Future in peril?
Topic: economy
The Bush domestic battlefield is littered with burned-out WMDs. Administration officials and assorted flunkies have hurled their most potent ordnance against Social Security, and thankfully most of the stuff fizzled or was defused by sound public opinion. But Social Security continues to suffer oblique attacks, especially from ‘independent” mass media. Fewer and fewer WMDs here - but lots of crapola-filled paintballs.

Look at what Democrat and Chronicle reporter Ben Rand fired off recently in a piece on Americans’ retirement prospects. Economic and demographic changes, said Rand, “are financially straining programs such as Social Security and Medicare.” This, he said, citing “experts,” will eventually “force profound social changes.” In passing, Rand let the business world off the hook, saying that an aging population, etc., will “make it harder for many companies to continue affording traditional pensions, health care, and other retiree benefits.”

Rand went on to cite an analyst at the Washington-based National Center on Policy Analysis, to the effect that “Social Security is clearly on a trajectory for insolvency.” This despite the conclusions from both the Social Security Administration and the nonpartisan Congressional Budget Office that the program will be able to pay all scheduled benefits over the full 75-year planning horizon, i.e. longer than the program has been in existence, with only tiny adjustments – maybe a tax increase of 1-2 percent. Many of you remember when the combined employer-employer contribution was around 15 percent of payroll, compared to around 12 percent today. I’m not proposing we go back to that – there are more progressive ways of doing things; I’m merely showing that any necessary change would be neither unimaginable nor unprecedented.

But Rand didn’t stop with underscoring this fib. He quoted an expert who maintained, “If we don’t do anything, Social Security and Medicare together will be taking a third of everything people earn in a few years. By the time today’s college kids retire, it will be taking half of earnings.” The expert added that any solution will “involve some pain in the form of reduced benefits.” But as the Center for Economic and Policy Research says, any “shortfall” in the future will require compensatory funding smaller than what we’re losing through the Bush tax cuts. So to translate from the expertise: we can’t afford history’s most successful and efficient social-welfare program and simultaneously let the rich keep getting endlessly richer at the majority’s expense.

By the way, Rand didn’t bother to inform us that the neutral-sounding National Center on Policy Analysis is a conservative thinktank headed by the ineffable Pete du Pont, hereditary foe of economic fairness. (Remember Grinning Pete's flat-earth, er, flat-tax nonsense from the 1988 presidential race?) A sample of the NCPA’s current offerings: a health policy heads-up from the Wall Street Journal with the redbaiting insinuation that “Canada is the only country other than Cuba and North Korea to ban private insurance and private care.” Why didn’t Rand go to CEPR or some other delightfully progressive source for another view? I wouldn’t even have minded seeing a standard tag, like “a foundation-supported liberal thinktank.”