Fixing health care under the table

At Common Dreams, Bill Moyers and Michael Winslip explain that you won't see the way the health care debate is being resolved if you only spent time on Capitol Hill. No, it's much slimier than that:

Katharine Weymouth, the publisher of The Washington Post -- one of the most powerful people in DC -- invited top officials from the White House, the Cabinet and Congress to her home for an intimate, off-the-record dinner to discuss health care reform with some of her reporters and editors covering the story.

But CEO's and lobbyists from the health care industry were invited, too, provided they forked over $25,000 a head -- or up to a quarter of a million if they want to sponsor a whole series of these cozy get-togethers. And what is the inducement offered? Nothing less, the invitation read, than "an exclusive opportunity to participate in the health-care reform debate among the select few who will get it done."

If you are not one of the highly-monied invitees or the "select few," forget about the debate because, politically speaking, you amount to nothing at all. That's the process. Go tell that to all the grade school students who are being taught lies in their civics classes. They are being taught that this is a democracy, and that our government is ultimately responsible to all of those people who were not invited to that fancy dinner. As the authors, explain, this particular dinner was canceled only after a copy of the invite was leaked to the web site Politico.com. It was, after all, a big misunderstanding. This peak at how important bills are passed is not an isolated case. It reminds you that when Congress passed the Helping Families Save Their Homes Act, "the select few made sure it no longer contained the cramdown provision that would have allowed judges to readjust mortgages." Here's another example:

Everyone knows the credit ratings agencies were co-conspirators with Wall Street in the shameful wilding that brought on the financial meltdown. But when the Obama administration came up with new reforms to prevent another crisis, the credit ratings agencies were given a pass. They'd been excused by "the select few who actually get it done."

Shame on us. Shame on our leaders for following big business instead of leading.

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Longitudinal study tells us what makes people happy

What makes people happy? On quite a few occasions, I've posted at DI with regard to ideas that I learned through reading various books and articles (a search for "happiness" in the DI search box will give you dozens of articles). What does that reveal about me, I wonder? Today, I had the pleasure of reading an extraordinarily thoughtful article on this same topic: "What Makes Us Happy?" by Joshua Wolf Shenk appears in the June 2009 edition of The Atlantic. You'll find an abridged edition of the article here. Shenk's article is anchored by the Harvard Study of Adult Development, the longest running longitudinally study of mental and physical well-being in history. It was begun in 1937 in order to study "well-adjusted Harvard sophomores (all male), and it has followed its subject for more than 70 years." The study was originally known as "The Grant Study," in that it was originally funded by W.T. Grant. Despite all odds, the study has survived to this day--many of the subjects are now in their upper 80's. Along the way, the study was supplemented with a separate study launched in 1937 dedicated to studying juvenile delinquents in inner-city Boston (run by criminologists Sheldon and Eleanor Glueck). You'll enjoy Joshua Shenk's work on many levels. He writes with precision, providing you with a deep understanding of the featured longitudinal studies. You will also enjoy his seemingly effortless ability to spin engaging stories (there are dozens of stories within his article) and his exceptional skill at crafting highly readable prose. I'm writing this post as a dare, then. Go forth and read Shenk's article and I guarantee that you will be thoroughly enriched and appreciative. The Atlantic also provided a video interview of George Vaillant, now 74, who since 1967 has dedicated his career to running and analyzing the Grant Study. As you'll see from Shenk's article, Vaillant is an exceptional storyteller himself. The Atlantic article, then, might remind you of one of those Russian dolls, and that is a storyteller telling the story of another storyteller who tell stories of hundreds of other storytellers. For more than 40 years, Vaillant has not only gathered reams of technical data, but he has poured his energy into interviewing the subjects and their families and melding all of that data into compellingly detailed vignettes of the subjects. Telling stories is not ultimately what the study was supposed to be about, of course, and Vaillant also tells us what those stories mean for the rest of us. Truly, what makes people happy? Vaillant offers answers that you will be tempted to immediately apply to your own situation. Vaillant has a lot to say about "adaptations," how people respond to the challenges they face in life. As a Shenk explains,

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FDA: Cheerios is claiming to be a drug

This news is astounding: The FDA, which for many years has worked hard to serve as a lapdog for its industry masters (not the taxpayers), has recently woken up and taken a real stand. The FDA has charged that Cheerios is "misbranded" as a drug that prevents and treats high cholesterol and heart disease. Caveat: The FDA warning letter doesn't cover all of the health claims on boxes of Cheerios. Here's an excerpt from the FDA warning letter to General Mills:

Based on claims made on your product's label, we have determined that your Cheerios® Toasted Whole Grain Oat Cereal is promoted for conditions that cause it to be a drug because the product is intended for use in the prevention, mitigation, and treatment of disease. Specifically, your Cheerios® product bears the following claims on its label:

• "you can Lower Your Cholesterol 4% in 6 weeks" " • "Did you know that in just 6 weeks Cheerios can reduce bad cholesterol by an average of 4 percent? Cheerios is ... clinically proven to lower cholesterol. A clinical study showed that eating two 1 1/2 cup servings daily of Cheerios cereal reduced bad cholesterol when eaten as part of a diet low in saturated fat and cholesterol."

These claims indicate that Cheerios® is intended for use in lowering cholesterol, and therefore in preventing, mitigating, and treating the disease hypercholesterolemia. Additionally, the claims indicate that Cheerios® is intended for use in the treatment, mitigation, and prevention of coronary heart disease through, lowering total and "bad" (LDL) cholesterol. Elevated levels of total and LDL cholesterol are a risk factor for coronary heart disease and can be a sign of coronary heart disease. Because of these intended uses, the product is a drug within the meaning of section 201(g)(1)(B) of the Act [21 U.S.C. § 321 (g)P)(B)].

I applaud the FDA's actions. Many food products are covered with comparable health claims, yet (until now) the claims have not been scrutinized by anyone other than the manufacturers. I suspect that a huge percentage of these claims would not hold up to an independent scientific review. I also suspect that many consumers make their food purchase choices based on these sorts of claims, many of them unsubstantiated. To the extent that a manufacturer gets a competitive leg up by making an unsubstantiated claim, this is an unfair practice that hurts manufacturers who are not stretching the truth. Now, the FDA will take a look at these claims of General Mills, and hopefully thousands of other food manufacturers, and we'll then see how many of those now-ubiquitous health claims start disappearing from products on the shelves. Too bad there's not an organized produce and grain industries that spends big money plastering signs all over produce departments (and billboards) telling people how good it is to eat fruits, vegetables and whole grains, and also telling consumers that there is no need to buy expensive processed food in wasteful packaging to be healthy. There's so many health claims stamped onto food products that walking down the grocery aisle makes me think I'm at a NASCAR event. I'm not trying to blast the makers of Cheerios here. My kids eat it--sometimes I do too. Perhaps these claims on the Cheerios boxes are justified. But let us investigate. Let us really find out before we allow the grocery aisle health claim wars to continue.

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Health-less

The boogeyman of Socialized Medicine is being dragged onto the field of rhetorical combat to block the move toward anything smacking of Single Payer Health Care in the United States. The argument is old and hoary by now, that adopting a system like that available in Canada or the United Kingdom would lead to a collapse of American health care. Somehow the fact that expenses might be shared and disbursed through the government will render the world’s best health care system somehow crippled inside a generation is not seriously questioned by most people. Because most people don’t know. You can find case after case of anecdotal evidence to support the notion that British health care is worse than ours. Someone knows someone who, as the argument goes. And there is something to that. The waiting periods alone, the pigeonholing of treatment—horror stories abound which we glimpsed here when HMOs were instituted and accountants seemed to be in charge of medicine. There is, in fact, too much information for the average American to digest much less make sense of. Technologically, the United States has an extraordinary medical system. Unmatched in the world, despite some annoyingly negative statistics. That we achieve what we do in a country peopled by citizens who do the least for their own health than in any other country comparably empowered is amazing. Americans eat too much. Medicine can only do so much against a rising tide of obesity related illnesses. The tradition of the doctor giving you a physical and then telling you to eat right and get some exiercise is not a quaint leftover from an age that didn’t know as much as we do—that is sound advice and more than half the battle in maintaining good health. The explosion of Type 2 diabetes in children has been alarming, and this can be tied directly to diet and exercise. We also work longer hours under higher stress than almost anywhere else in the developed world. The need for vacations and long weekends is acute. This may sound sarcastic, but the link between stress and several major illnesses is no joke. We are also a violent society. If one looks at emergency room statistics, it becomes quickly clear that we are a people who like to beat, stab, and shoot each other at higher levels than almost anywhere else. What makes all these factors so overwhelming is that we have the means to do all this. Because a certain percentage, a significant percentage, of the population can afford to go to the doctor and have the consequences of all these lifestyle disasters “taken care of.” I put all this out front because the one factor that is muted in the national debate over the rising cost of healthcare is the fact that we are, collectively, idiots. We do not do, statistically, the simplest things to avert the need for medical intervention. The last detail in this litany has nothing to do with idiocy but with sentiment and perspective. It has been said for decades and it is true—80% of individual health expense in this country is spent in the last two years of life. We are, as a people, loathe to die and we will direct our health services to do absolutely everything to give us another day. In Europe, such people are told to go home and die. That sounds cold, I know, and I’m sure there are people in France and Germany and Italy with the resources to reject this advice. But the nations as a whole are not expected to pay for it. Here we are. Through health insurance.

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Dennis Kucinich takes on the Manhattan Institute

What is the deal with single payor? How does the United States compare to Canada on the ability to provide health care services? Rep. Dennis Kucinich is showing his frustration with Dr. David Gratzer, Senior Fellow of the conservative Manhattan Institute. Gratzer had it coming because he presented himself as an expert on the problems with the Canadian system. See here and here. For a clear presentation of why we do need single payor insurance and why we can afford it, see this report by Marcia Angell, M. D., Senior Lecturer in Social Medicine Harvard Medical School.

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