A Fight Among Cannibals

We live and function in an “official” economy which is run by a very small group of very rich people. Their goal is continued economic “growth”, yet what that really means is continued growth of their profits. In the days before the present limits on the resource base of the global industrial economy, this growth could be achieved by industrial expansion. But now that our natural resource base has become constrained, the growth of the profits of the rich increasingly comes only by the robbing of the poor.

A prime example of this is the big ongoing Congressional song-and-dance over health care “reform.” It should be fairly obvious that universal health care is not the same as universal health “insurance.” The Congress could have aimed for universal health care for all Americans, regardless of income. The money spent on bailing out the banks and Wall Street could easily have covered the cost of universal health care. The money spent on the Iraq war could easily have covered universal health care. Even under our present arrangement, there would have been lots of change left over. And the elimination of the private insurance “industry”, combined with Federal prohibitions on unjust medical price inflation by pharmaceutical companies and hospitals would have made our care just that much more affordable.

That sort of genuine reform was never seriously attempted by anyone in Congress or the Executive Branch. The medical industry was too strong, having grown to 1/8^th of the total U.S. economy, according to this source: Health Care Reform: Problems for Human Health. The best our leaders could come up with was a proposal for a Government-run insurance plan that would have competed with private insurance companies. Private insurers are at present hideously expensive, with rates that rose at an annual rate of up to 13 percent in 2002 and 2003, and are rising at a rate of five percent per year now. The private insurers were deathly afraid of the mere possibility of Government-backed insurance, let alone genuine health care reform, and worked hard to kill this option, in a Senate Finance Committee vote which took place last week.

The Senate Finance Committee has therefore settled on a “reform” plan that would force all Americans to buy private health insurance by 2013. This plan is a “compromise” worked out by Democrats in order to appeal to Republicans who were afraid of the “Government spending taxpayer money to support socialism!!!” However, under this plan, ordinary Americans would be forced to spend:

• up to 13 percent of yearly (pre-tax) income for a family of four making up to $88,000 a year;

• over $700 a month for a family of four making $66,000 a year;

• and a tax penalty of up to $1500 a year for those who refuse to buy health insurance and whose earnings are less than 300 percent of the poverty level, and $3800 a year for those who refuse to buy health insurance and whose earnings are greater than 300 percent of the poverty level. (Source: “Reform Bill Will Address GOP Fears,” Washington Post, 15 September 2009)

And our leaders call this “fixing health care”?!

I wonder now...so many families are now heavily indebted, having been tricked into buying overpriced houses and overpriced cars, having had to make ends meet with stagnant or declining real wages while the prices of basics like food, gasoline and utilities continue to rise. So many students have been drawn heavily into debt to attend colleges whose tuition continues to rise at a rate far outpacing general inflation. So many people are now either laid off or are on involuntary part-time schedules. So many small business owners have been given the business by this present “recession” that has put them out of business. The only green shoots one sees in the vicinity of many empty and boarded-up strip mall lease spaces are the shoots of weeds rising through the cracks in the pavement. And I do see a lot more people in raggedy clothes next to freeway off-ramps, holding up signs saying something like “Please give. Anything helps. God bless!”

Is the Government going to force these people to spend $700 a month on private health insurance? Is the Government going to hit these people with a $1500 or $3800 a year tax burden if they don't buy insurance? And what kind of insurance would they buy? The insurance lobby and their Republican sock puppets would propose making insurance “affordable” by offering plans with high deductibles in order to “keep costs down.” So that means that Americans are forced to give money to private insurers, and that they get almost nothing in return? If you buy one of these plans, does that mean that eighty or ninety percent of the cost of a doctor's visit is not covered by insurance? That's like getting into an airplane and being handed a parachute the size of a handkerchief. It won't slow you down much, will it?!

Now people like Glenn Beck and the Tea Party organizers claim to be fighting for the American taxpayer. Why are they not protesting this plan to force Americans to buy private health insurance? Why isn't Fox News protesting this? Why isn't Sarah Palin outraged over this? Are the Tea Partyers all “partied-out”? Or are they on the side of the enemy, after all? And why are both Democrats and Republicans helping the insurance “industry” to rape ordinary Americans?

For a rape it is, or to use another metaphor, it is a cannibal feast. Ordinary Americans have now been reduced to little more than a pile of body parts and limbs, some of which have already been picked clean. The cannibals comprise a small group, yet among them are competing interests. Each representative of these interests wants as big a share as possible of the pile of body parts and limbs, because each competing interest wants to grow as fat as possible.

So we have the private prison lobby, which wants to grow rich locking up as many Americans as possible. But wait – if they do that, that will hurt the growth prospects of the real estate “industry,” who will not have anyone to buy their excessive housing inventory. But if people buy houses, and their wages don't rise, they won't be able to afford consumer electronics and cheap Chinese-made goods, and this would hurt Wal-Mart and other big chain stores. Now the medical/insurance complex wants its share of the cannibal feast – “hey, let's extort $700 a month from every American family to fatten ourselves!” But that will mean that people don't have money anymore to go to Starbucks or to keep their cable TV subscriptions, or to buy new cars, or to buy stocks, etc.

What to do, what to do? How will the competing cannibals sort it all out? I don't know. Perhaps they will all get into a fight with each other, killing each other off and leaving the rest of us alone. I have to confess that I would enjoy seeing such an outcome. Lord, forgive me.

Meanwhile, if you want to see an example of genuine citizen rage and not some store-bought Tea Party astroturf purchased by rich lobbyists, here's a link to a YouTube video of a woman delivering a few words to Bank of America. I must warn you that her language is not family-friendly. Yet I say “Amen” to her message. Here's the link: http://www.youtube.com/watch?v=jGC1mCS4OVo

Where There Is No Doctor (Because You Can't Afford One)

Much of this blog has focused on the ongoing economic collapse in the United States, and the warped economic arrangements that prevent ordinary people of small means from becoming resilient in the face of that collapse. American health care is just one aspect of these warped arrangements. Because health care in America is provided by a private “industry” that demands ever-increasing profits, the cost of American health care has become an ever-more-weighty and insupportable elephant on the backs of ordinary people.

Of course, this has led to the widespread suffering of ordinary people, and has generated much attention from politicians who have promised to “reform” the system. Genuine health care reform would consist of transforming American health care from a growth industry to the providing of an essential service, in all likelihood administered by the Government because of the proven untrustworthiness and selfishness of the private sector. Unfortunately, our leaders in government seem utterly unable to come to this conclusion. The best they can do is talk about providing universal health insurance (which is not the same as universal health care) to all American citizens. Their so-called “public option” would consist of a Government-run insurance program that would compete against private health insurance providers. This last week, the Finance Committee of the United States Senate voted twice to reject this “public option.” As things now stand, therefore, we ordinary people are about to be left once again at the mercy of the health care industry and its adjuncts, the pharmaceutical industry and the insurance “industry.”

But there is another option available. It is a “public” option, though it does not depend on the Government for its implementation. Who is responsible for implementing it? You are, dear reader. Today, let's talk again about citizens building a safety net of alternative systems for themselves. I must warn you that the steps of building a citizen-created health care safety net will be somewhat challenging. Some study and hard work will be required. But I have no doubt that many people will be sufficiently motivated for the task, once they find themselves thrown out of work by the present economic contraction. When their unemployment checks total less than $1300 a month and they are faced with COBRA payments of almost $1100 a month, that will be a real kick in the pants! (Source: COBRA Premiums for Family Health Coverage Consume 84 Percent of Unemployment Benefits)

By the way, health insurance payments have risen over 131 percent from 1999 to the present. COBRA payments in some states now exceed the size of mortgage payments on small to mid-sized houses. (Sources: Health Inflation Slows as Economy Tumbles, KFF Reports, and Insurance Premiums Still Rising Faster Than Inflation and Wages.) Thus, one other aim of my “public option” is that it would kill off the private health insurance “industry” in the U.S. if it were widely adopted. And that “industry” is ripe for the killing, if you ask me. (There is yet a third aim: to shut up all the "tea party" idiots now yelling about illegitimate birth certificates and "socialism!!!")

One caveat: I am not a doctor, but an engineer by training. I can't take someone's blood pressure or interpret what I would see if I stuck a tongue depressor into someone's mouth and told them to say “Ahh.” But I'd like to believe that I'm a somewhat competent systems thinker, and it seems to me that the health care problem is a systems problem with a systems solution. My proposed citizen-generated health care alternative therefore addresses three specific system concerns: preventive health care, infectious disease control and injury treatment.

Why these three concerns? What about degenerative diseases such as hypertension, Type 2 diabetes, osteoporosis, and so forth? I believe that a proper emphasis on preventive health care education and preventive health habits would greatly reduce the incidence of many degenerative diseases in the American population. If people took proper care of themselves and lived in unpolluted environments, the only threats to their health that they'd have to worry about would most likely be the threat of infectious illness and the threat of injury.

Preventive Health Care

Preventive health care consists of many elements that are already familiar to most of us, such as the development of healthy habits like eating right and exercise. If you see your body as a machine, it should be obvious that a properly maintained machine is less likely to break down in the first place. We need to learn to maintain ourselves.

Of course, part of that maintenance has to do with how we eat, and how much we eat. But another part of that maintenance consists of proper exercise. By this I don't mean the sort of “exercise” that's often sold at chain-store health clubs. I mean real, functional physical conditioning that enables people to do strenuous things without hurting themselves. My personal leanings are toward the Crossfit program (www.crossfit.com) and its teachers, although I don't agree with everything they say, and their classes are too expensive for me. (Also, I'm not quite as hardcore as they are.) But I like the fact that they encourage people to work hard, to develop functional capabilities that actually have some use, and that they are willing to train anyone for strength, from children to the elderly. By starting people off young and training them in a wide variety of fitness strategies, they help people build a solid foundation for maintained physical capability in later life, without worries about things like osteoporosis, injuries and other fractures, circulatory diseases, and diabetes.

Exercise should be a family affair. If you want strong, capable kids, you've got to work yourself to be strong and capable. I remember when I used to live in Southern California, that there was a horse/nature trail near my apartment. The trail head was right behind a County courthouse, and wound around past a medical office complex before ending again at a small man-made “lake” (a pond, really). Sometimes when I walked that trail, I would encounter a large family jogging past me. Usually their group consisted of several of the kids, the oldest of whom was in high school. But one time I think I saw the entire family – Dad, Mom and all the kids (they had many) running along in shorts and jogging shoes, with the youngest (who seemed to be around nine or ten years old) pounding along at the rear. That family was an inspiration and an example to me. May they be so to you also. So get off the couch, put out the cigarette, put down the sour-cream-and-chives potato chips, turn off the TV and start modeling some good behavior.

Dealing With Illness and Injuries

Last week's post, Communities of Healing Hands - The Hesperian Example, described the work of the Hesperian Foundation in developing simple, practical printed literature to teach untrained health care workers how to help sick and injured people. The writers of this literature strove to provide health care workers with tools that are uncomplicated, widely available, inexpensive, and easy to implement.

Ordinary Americans who want to free themselves from worry over possible medical emergencies should master this literature. As many people a hundred years ago knew how to treat a fracture, how to clear a boil, and how to deliver a baby, I think it's going to be necessary for many of us to re-learn skills like these if we don't want to be bankrupted by the medical “industry.” We are also going to have to learn to make our own medicines, and how to deal with infectious diseases. And we are going to have to learn to identify environmental factors that make people sick, and learn what to do about these.

As the Introduction to Where There Is No Doctor says, “...even where there are doctors, people can and should take the lead in their own health care...Health care is not only everyone's right, but everyone's responsibility...Informed self-care should be the main goal of any health program or activity...”

Educate, Practice and Agitate

It's time to educate ourselves, and to practice the techniques we learn through this education. Our goal should be to create community-based health care systems that work so well that we no longer need health “insurance” or special access to the overpriced products of the present health care “industry.”

If this goal appeals to you, then consider buying the Hesperian literature (or downloading it for free from their website). Start a reading/discussion circle to study this literature with friends, neighbors or co-workers. (At my job, we're going to kick off a study group for Where There Is No Doctor. Our first meeting is a week and a half from now.)

If you want an opportunity to practice what you learn, consider volunteering to provide basic health care services for the homeless, or at a local rescue mission. Document your efforts, along with any lessons learned, in a form such as a blog that allows a large audience to learn from what your doing. Try to analyze and measure the effectiveness of your efforts, and compare them to the results that would be provided by the standard American health care system.

As I have said, the Hesperian literature is written at a very basic level. But for those who want a more advanced theoretical background knowledge of health care, the Massachusetts Institute of Technology has provided online study materials for its Health Sciences and Technology curriculum under its Creative Commons-licensed OpenCourseWare. There are also many other sources of open-source or Creative Commons-licensed health care and health education information on the Web.

Lastly, we need to agitate. Where there are institutional, legal or political barriers to community-created health care, these must be publicized and those who create these barriers must be shamed. This is especially true where available cheap generic drugs are blocked from the market by powerful pharmaceutical interests and their political hired guns. I think of the way in which cheap Canadian generic drugs have been blocked from being imported to the U.S. by means of Congressional legislation. This legislation was especially ridiculous in 2006, when Republican congressmen argued that by banning the entry of cheap Canadian generics they were helping to protect the U.S. from terrorists! I wonder what drugs those Republicans had been taking...

Communities of Healing Hands - The Hesperian Example

In my last post, Making The World Sick, One Country At A Time, I stated some key facts to illustrate how the American health care system prevents ordinary citizens from achieving economic resilience and self-sufficiency by bleeding them dry. I also said that I don't really expect the U.S. Federal government to enact any serious health care reform of the kind that would lighten the financial burden on the backs of ordinary users of American health care. I then stated my opinion that over the next several years, American health care will probably come to resemble the care provided in many Third World countries. (By the way, there are signs that this is happening now.)

My post then explored the sort of care that is now provided in the Third World, as well as explaining the philosophy behind much of that care as embodied in the 1978 Alma Ata Declaration of the World Health Organization. I cited the concept of Primary Health Care (PHC) embodied in that Declaration, as “...essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford...”

I then described how rich First World entities such as the World Bank and International Monetary Fund have worked to weaken Primary Health Care in the developing world, how they have forced the governments of Third World countries to dismantle their government-provided social services, and how they have worked instead to force an American-style privatized system of health insurance coverage on the poor citizens of the developing world. This failure to achieve a universal good for the world's people has occurred because the attempt to achieve this good relied on national governments that were beholden to selfish, rich corporations and other holders of concentrated wealth.

Yet there are good examples of individuals and volunteer organizations banding together to create social safety nets, including basic affordable health care, in the Third World and in the poorer parts of the First World. These groups are often quite innovative, due to the limits on the resources at their disposal, and the work they do is worthy of high praise. In his paper, “The Life and Death of Primary Health Care,” David Werner makes mention of the good work of non-government, community-based health programs and the groups that administer them.

One such group deserves particular mention. The Hesperian Foundation (http://www.hesperian.org/), based in Berkeley, California, is a non-profit publisher of books and newsletters for community-based health care, as stated in the “About Us” section of their website. Their published information is developed in collaboration with formally-trained doctors, citizens of poor communities in the developing world, and untrained or informally trained health care workers in these communities. Their literature is very simply written and is designed for people without any formal medical training, and it not only covers the treatment of disease, but also covers the underlying social factors in building healthy communities. Their most well-known book is Where There Is No Doctor, a book that has almost become the Bible of primary health care in the developing world. Hesperian has also joined forces with the worldwide People's Health Movement to promote health for all and the widespread implementation of Primary Health Care as defined in the Alma Ata Declaration.

I recently had a chance to conduct an e-mail “interview” of the Hesperian staff, which I have included as part of this present post. My questions are written in bold type, and their answers to each question are shown immediately below that question. I would like to especially thank Hesperian staffer Ingrid Hawkinson for taking the time to reply to my e-mail inquiries and to collect all the answers to my questions. The approach set forth by the Hesperian Foundation could prove to be a vital part of the response by ordinary Americans to our present health care crisis.

In reading the “Our Philosophy” section of your website, it seems that you have incorporated all of the principles of the 1978 Alma Ata declaration of the World Health Organization. That declaration defined health as “...a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity...” and stated that health is a fundamental human right. It also went on to address the underlying societal factors that influence the health of a nation. Are you familiar with the Alma Ata Declaration, and was it an influence on your philosophy?

Yes, we are definitely familiar with the Alma Ata Declaration – we have spent the past 30 years building on the successful model of Where There Is No Doctor to create other resources that also help people discover not only the ways they can have equal access to health care, but to do so in a sustainable way that examines the social, economic, and political issues that not only block access, but make our communities unhealthy. In line with the Alma Ata Declaration, our mission is to achieve the right to health for all people.

If ordinary people put their heads together to examine their health problems, come up with solutions, and organize, so many issues will be addressed including the power balance, the state of the environment, our sense of wellbeing. . . The concept of “health” and the reasons behind poor health are woven into the fabric of our existence.

Your programs match the definition of “Primary Health Care” as stated in the Alma Ata Declaration. After that Declaration was issued, many rich First World nations protested that implementing this Primary Health Care would be too “expensive.” Yet you seem to be able to provide what rich First World governments could not. How do you do it?

What we do is very simple. We supply information that people can use in formats they can understand and easily share. Our books are developed collaboratively to ensure they make sense to the end user. Once this information is in people’s hands, they come up with solutions that work for them. So if, for instance, our readers don’t have money, our books help them figure out how to take care of their health using the resources available to them under the circumstances, and to prevent health problems before they become serious and costly.

One barrier to affordable health care is that there’s so much mysticism surrounding what doctors do. Yet the methods doctors use to diagnose and treat the most common and basic health problems are simple. In addition, the vast majority of medical information is available but not accessible. Typically, it is in dry, expensive textbooks full of elaborately constructed sentences; jargon confusing even to those studying medicine; and illustrations that depict illness rather than communicate ways for the viewer to visualize a concept or technique that will lead to its cure.

Another barrier is that many rich, first-world countries are run by governments supported by industries with a lot of money, such as the healthcare industry. And of course, if people could spend much less money on health care, they would. It’s not in the interests of governments to champion alternatives to the industries that supply their funding. Their argument -- that providing a single-payer program would be too expensive -- strikes those who are suffering right where it hurts: in their pocketbooks. The argument is illogical, yet it’s still somewhat effective because it weakens those who have the most potential to make change.

You have evolved a community-based, non-governmental approach to providing health and basic human services. Yet I am sure that you have interacted with governments in the nations where you work. Have you been able to collaborate easily with them? Are there any cases in which the relationship was strained or in which you faced opposition?

We are based in Berkeley, California, and we don’t provide health and human services – we produce materials to allow ordinary citizens to improve their health and organize for justice. We have an open copyright policy that encourages people to translate and adapt our books to suit their communities. Those who do adapt our materials negotiate with their own governments. We don’t normally work directly with other governments, though many large governmental health agencies use and distribute our materials.

Over the last two decades, the World Bank and International Monetary Fund have pushed many governments in the developing world to dismantle their social safety nets, including free health care. Have you ever encountered opposition or hindrances from the World Bank and IMF, or from First World governments, or from for-profit providers of Western medicine?

No, not that I know of.

What are some of your opinions about the present health-care reform debate in the United States?

Health care needs reforming, and as currently outlined in H.R. 676, with a single-payer system in which the government is the only health provider. In the United States, we could eliminate co-pays, deductibles, and employer contributions. At the same time, additional taxes would be added to individuals and employers (see the Healthcare-NOW website for a clear explanation of how H.R. 676 funding would work).

It is quite possible that the present recession will deepen, especially in the United States, while medical costs continue to escalate, and that there will be a sharp rise in the number of Americans without access to a doctor. If that happened, could individuals and communities in the U.S. implement the programs and approaches that the Hesperian Foundation has developed for the world's poorer countries? What would be the potential barriers and sources of opposition to such an approach?

Yes, absolutely, people in the United States could implement the approaches in our books, and some do already (people living on reservations, nurses, midwives, employees and volunteers at free clinics, travelers and sailors, professors of public health and environmental studies, ministers. . .). The only barrier is lack of knowledge and an unwillingness to change.

Is there anything you'd like to mention that I haven't covered?

• Most of our books are available for free download. We encourage you to print and share them.

• If anyone is willing to help us spread the word and spread health by posting a review, talking about our books on the radio, reviewing them in a magazine or newsletter, or by any other means, please contact Ingrid@hesperian.org.

• All profits from the sales of our books go towards printing, updating, revising, and creating more books, and also to our Gratis book program and Translations fund, both of which get health information into the hands of people around the world who might not otherwise have access to it.

• Give someone a present that really matters – send a gift of health to a poor community on behalf of a friend or loved one.

• We are currently working on a New Where There Is No Doctor for the 21^st Century, a new edition of HIV, Health and your Community, a Spanish translation of A Community Guide to Environmental Health, a Community Action for Women’s Health and Empowerment, and A Worker’s Guide to Health and Safety.

Making The World Sick, One Country At A Time

(Warning: this is a long post.)

The predicament that marks the probable end of our industrialized society has two stages. The stage most easily visualized by many of the first thinkers on this subject has its roots in the Limits To Growth scenarios first analyzed by the Club of Rome. Its most popularized images look like scenes from a dystopian science-fiction movie starring Charleton Heston or Will Smith or Mel Gibson or Harrison Ford – famine and the failure of technology; poisoned landscapes and cities with zombies running in the streets; “World of Warcraft” meets “Survivor” – in short, a “hard crash.”

However, there is a prior stage to the effects of resource scarcity: economic upheaval and contraction. The images that fit this are found in Dorothea Lange Depression-era photography; scenes from John Steinbeck's Grapes of Wrath; the Dust Bowl; tent cities; people losing jobs as the economy contracts; people being priced out of oil-based “necessities” as prices continues to increase; and people being thrown out of their homes, having their things repossessed and living under bridges due to “lack of sufficient funds.”

The second stage may be coming shortly, but the first stage is where we are now. The response to the onset of this first stage on the part of leaders in government and commerce by and large is as follows (there are, of course, exceptions): 1. A refusal to rearrange the social/political/economic systems under their control to make them more resilient in the face of the disruptions of Stage Two; and 2. A manic attempt to sustain their existing systems, which are unsustainable, and for which the writing is already on the wall. The leaders in government and commerce are now diverting all available public resources to this attempt to sustain the unsustainable.

Preparing for industrial and economic collapse in all its stages is therefore up to individual citizens. The captains of finance, economics and government will not institute the necessary changes, because such changes would reduce their power, prestige and access to wealth. This is why it's up to citizens. Yet the very nature and policies of the existing systems and their masters actively hinder the efforts of ordinary people to become resilient in the face of collapse. This hindrance comes either through government policies and laws that make resilience difficult, or through economic arrangements that bleed ordinary people dry so that they have no resources left for building resilience.

Such is the case with health care in the United States, that act of formerly selfless service embodied by the family doctors of decades ago and television doctors such as Dr Kildare, Ben Casey and Marcus Welby. This “service” has metastasized into a money-sucking “industry” so expensive that whereas the normal delivery of a live baby cost less than $100 in 1950, it now costs anywhere from $6000 to over $12000 today. According to one source, American national health spending is expected to reach $2.5 trillion in 2009, accounting for 17.6 percent of gross domestic product (GDP). Health expenditures are expected to increase at a rate of 6.2 percent per year from now to the year 2018, which is faster than even the most optimistic estimates of growth in GDP for this period. Part of the expense of American health care is due to exploding administrative costs. But there are other contributors, such as costs for prescription drugs that are rising at over twice the rate of inflation, cost increases for medical equipment and consumables, and inflation in employer-sponsored health insurance premiums which have risen at four times the rate of inflation during the past decade.

There's been much controversy this year over the possibility of Federally mandated health care reform. I really don't expect the Democratic or Republican Parties at any level of government to craft genuine reform of the sort that would lighten the economic burden for the recipients of that care. Some of our expectations regarding American “health care” may also be unrealistic, including the expectation that the Government can afford to pick up the tab for health care as it is currently practiced in the U.S. for all residents of the U.S. My suspicion is based not only on the unjustifiable rate of rise in American health care costs, but also on the fact that most of the wealth we could have devoted to equitable Government-backed health care and other safety nets has been squandered on covering the monetary losses of the rich. Our remaining tax revenues will largely be dedicated to servicing our large public debt, and the ability of our government at all levels to borrow additional money will shortly be severely curtailed.

I think it is also unrealistic for the masters of the health care “industry” - the doctors, hospitals, HMO's, insurance providers, drug companies and providers of medical technology – to expect that the system they have created can survive unbroken and unchallenged once almost no one but the rich can afford to use it. Already that system has priced 86.7 million Americans out of health care from 2007 to 2008. In 2008, at least 46.3 million Americans were without health insurance for a full year, according to the U.S. Census Bureau. In 2009 these numbers will only increase, due to the explosion of job losses, exhaustion of workers' unemployment benefits and continued escalation of insurance costs.

In short, I expect the nature and experience of health care to change drastically in the United States over the next several years. Increasingly, it will resemble the care provided in many Third World countries. Hopefully we will witness the adoption of some of the more beneficial and fair systems now operating in the Third World. Yet before we all rush to the countries of the developing world for inspiration and guidance, we need to see how the architects of the present American system of health care have attempted over the years to wreck viable, low-cost Third World alternatives. These attempts at wreckage were intended to protect and increase the revenue streams from the world's poorest people to the First World providers of expensive medical intervention and treatment.

The History of Western Medicine in the Third World

In his paper, “The Life And Death Of Primary Health Care,” David Werner writes that from colonial times until recent decades, the providing of Western medical service to the Third World was not equitable. The most expensive services were directed to the privileged, whereas health services directed at the “natives” were few, and were designed mainly to keep them healthy enough to work for the rich. But in the post-World War II era, there was a dawning awareness of health and health care as fundamental human rights. This led to efforts by rich countries to make Western medical practice more widely available in Third World countries.

However, this approach to expanded health care proved to be unsustainable, since Western medicine was too expensive even then for most Third World governments to widely support, or for indigenous peoples to use. This was partly due to the influence of budding multinational pharmaceutical corporations whose advertising induced a dependence on expensive treatments while eroding traditional forms of self-care. By the late 1970's it was widely recognized that the standard Western model of health care was failing in the developing world. This realization led to an international health care conference hosted by the World Health Organization in Almaty (formerly Alma-Ata) in the former Soviet Union in 1978.

Alma-Ata And Its Aftermath

The Alma-Ata Declaration of 1978 defined health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity...” This declaration set forth this health as a primary goal to which governments should strive, and deemed existing health inequalities to be unacceptable. In order to achieve the goal of universal health, the declaration proposed a “Primary Health Care” which was defined as “...essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford ...”

The implementation of this Primary Health Care was to involve all major elements of community life, such as sanitation, the provision of safe and healthy food, access to clean drinking water, housing and other basic needs. Very importantly, this implementation was to be community-based, “...requiring and promoting maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and...developing through appropriate education the ability of communities to participate ...”

The Alma Ata Declaration was revolutionary its emphasis on addressing the root factors of health and giving ordinary people more control over their health and lives. It proved to be too revolutionary for the heads of the governments of the First World, who systematically transformed Primary Health Care into merely another program for extending conventional Western, top-down health services into the Third World. This was accomplished by the promotion of “selective” Primary Health Care by donor countries; by the increased shifting of costs of Western medicine onto end users (ordinary poor people) via “Cost Recovery”; and the takeover of health and social policies of Third World governments by the World Bank and the International Monetary Fund (IMF), which enticed many countries into taking loans with ruinous repayment terms, then forced those debtor countries to dismantle their social safety nets as part of their repayment.

One word on “selective” Primary Health Care: one of its initiatives was the so-called “Child Survival Revolution” that focused on growth monitoring, oral rehydration therapy (ORT) (for diarrhea), breast-feeding and immunization. The approaches implemented in this “Revolution” favored expensive treatments sold by pharmaceutical corporations – especially the pre-mixed ORT packets that were pushed instead of homemade foods and liquids.

The gutting of Primary Health Care as a viable option, combined with the World Bank's forcing debtor countries to dismantle government-sponsored social safety nets, led to a deterioration of health in the developing world. In addition, the World Bank has insisted on privatization of services formerly provided by governments, and has been an active agent in expanding the role of private health insurance in Third World health care.

American-Style Health Insurance – Coming To A Country Near You

Private health insurance is a very fast-growing worldwide market. The insurance “industry” is especially interested in the developing world, where it grew more than twice as fast as in the First World from 1994 to 2004. The promotion of private health insurance is especially attractive to the Organisation for Economic Co-Operation and Development (OECD), an association of thirty nations, most of whom are the richest in the world, and whose member countries are home to the largest multinational insurance and investment firms. One OECD study notes the extensive penetration of private health insurance in Latin America, while discussing strategies such as subsidized coverage in order to boost penetration in East Asia. However, even the authors of that study admit that the introduction of private health insurance “...might also lead to cost escalation, a deterioration of public services, a reduction of the provision of preventive health care and a widening of the rich-poor divide in a country's medical system.”

Private health insurance is threatening to displace other options, partly through advertising that seeks to induce dissatisfaction with public health care, and partly through the promotion by the World Bank of so-called “free market” policies and privatization of social services in Third World countries. In fact, since 1993 the World Bank has pushed a view of Third World health care as simply a means of enhancing worker productivity for economic growth – a view that is very similar to the colonial view of the purpose of medicine in the Third World: to keep the natives healthy so they can work for the rich.

Conclusion

Because of the power held by the medical and insurance industries in the United States, I expect that the present attempts by our leaders to “reform” our health care system will turn out as badly as the attempt by the WHO to implement the Alma Ata Declaration. As that declaration was thwarted by the rich, I expect that our health care “reform” will also wind up as simply another means of moving money from the pockets of poor people into the coffers of the rich. Ah, but that's what our health care system is already...

Sources:

• “Health Insurance Costs,” National Coalition on Health Care, http://www.nchc.org/facts/cost.shtml

• “Paying The Price: The High Cost of Prescription Drugs For Uninsured Americans,” Maryland Public Interest Research Group, http://www.marylandpirg.org/home/reports/report-archives/health-care/health-care/paying-the-price-the-high-cost-of-prescription-drugs-for-uninsured-americans

• “Employer-Sponsored Health Insurance Erosion Continues, Will Likely Accelerate Through 2009,” Elise Gould, Economic Policy Institute, September 2009, http://www.epi.org/publications/entry/jobspicture_20090306/

• “The Life And Death Of Primary Health Care,” David Werner, International People's Health Council Global Summit, 1995, www.healthwrights.org/.../Life_and_Death_of_PHC-Global_Summit_Sweden.pdf

• “Health for All Beyond 2000: The Demise of the Alma-Ata Declaration And Primary Health Care in Developing Countries,” John Hall and Richard Taylor, The Medical Journal of Australia, 7 November 2002, http://www.mja.com.au/public/issues/178_01_060103/hal10723_fm.html

• “Declaration of Alma-Ata,” International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978, World Health Organization, www.who.int/hpr/NPH/docs/declaration_almaata.pdf

• “Rich Countries and World Bank Must Stop Pushing Privatized Health In Poor Countries,” OXFAM International, 12 February 2009, http://www.oxfam.org/en/pressroom/pressrelease/2009-02-12/rich-countries-world-bank-must-stop-pushing-privatized-health-to-poor

• “The IMF And The No User Fees Policy In Health,” Sandra Graham, Jamaica Observer, 15 August 2009, http://www.jamaicaobserver.com/columns/html/20090814T200000-0500_157495_OBS_THE_IMF_AND_THE_NO_USER_FEES_POLICY_IN_HEALTH_.asp

• “Private Health Insurance for the Poor in Developing Countries?”, Denis Drechsler and Johannes Jütting, OECD, August 2005

• “Is there a role for private health insurance in developing countries?”, Denis Drechsler and Johannes Jütting, German Institute for Economic Research, October 2005

Intermission - September 2009

I will not be posting anything heavy this week. Instead, I'm taking a bit of a break. However, I hope to have another post for you all next weekend, followed by another short break. Thanks for all your readership and comments so far.

In the meantime, some of you may want to check out Trimet Confidential (http://danbusdriverman.blogspot.com) to get a taste of public transit through the eyes of a bus driver. Trimet Confidential is written by Dan, who is a follower of my blog, The Well Run Dry. (Fortunately, my transit trips usually aren't nearly as exciting as some of his stories.) One day, I hope to run into Dan the Bus Driver Man. I'll get on his bus, show him my transit pass and say to him, "Are you Dan? I am TH in SoC..."

The Secret Lives Of Wage Slaves

There's a Russian church near my house, to which I have paid occasional visits over the last year or so. On one of my visits, a recently married young man volunteered to translate for me. (A good thing, since my Russian is rather horrible – almost nonexistent, in fact.) After the service, we got to talking and he found out that I play guitar. So he asked me if I could teach him. I told him that I'd be glad to teach him – for free. Thus he has been coming to my house once a week for the last several weeks to learn.

I'm a big fan of learning the fundamentals of music, including learning to read notes in standard notation. This is something that many guitar instruction books and teachers gloss over, preferring instead to teach a few chords and the tabs (tablature) to a few American pop hits. On the other hand, what I have been doing with my student is to teach how to read notes on the musical staff and how to play them in first position. Later, we will hopefully move on to more fun stuff.

My student does not mind my approach, and in fact he seems eager to learn. But last week, I have to admit that he sounded like he hadn't been practicing as much as he should. We have covered all six strings in first position, yet when he was playing the short version of “Spanish Study” in Frederick Noad's black Solo Guitar Playing book, he was missing some of the notes on the lower three strings.

So why wasn't he practicing as he should? Was it because he was losing interest? Was it because I was a boring teacher? Or was it because of his job, which involves on-site customer service for office equipment, and which had forced him to be on the road from 7 in the morning to 7 at night on the day he came to my house? And is it reasonable to suppose that his job regularly requires such long hours?

Why work so hard, one may ask. That's a very good question. Maybe it has to do with the fact that our cost of living is so elevated, even now. My friend is a renter. Rent for a one bedroom apartment in our town runs over $1,100 a month according to this source: Portland, Sweet Sixteen? For Singles. Rental homes cost around $1200 a month on average, although some smaller homes can be had for around $900. My friend rents a house, but I haven't asked him how much he pays each month.

(I have another neighbor, with a wife and young son, who lives very near me in Portland, yet works in Salem. He's on the road before the sun rises, and when he comes home on weekdays, he has time only to eat and get ready for bed. He's hemmed in by his circumstances, with a lack of other jobs of his type to which he could easily transfer. He's been trying to sell his house so he can move closer to where he works, but selling is next to impossible in these times.)

My guitar-learning friend also needs medical insurance, I am sure. This is especially true because of his wife, who will one day have a baby, I suppose. I've heard that having babies can be quite expensive ($6,000 to $8,000 for a normal delivery and $10,000 to $14,000 for a caesarian section if you're not insured, according to this source: http://pregnancy.thefuntimesguide.com/2009/01/cost_to_have_a_baby.php). Even those with insurance must pay over a thousand dollars for a delivery. By the way, in 1950, the cost for a normal delivery was eighty-six dollars and thirty-three cents. (Source: The Cost of Having a Baby... in 1950) The American infant mortality rate was lower in 1950 as well.

My friend drives a relatively new car. It's not an extravagant car by any means, yet it is the sort that a man would buy if he was starting a family. I know that such cars are not cheap. If a man wanted to buy a “family-mobile” like a 2009 Honda CR-V, for instance, he'd have to pay around $22,000 for a base model. With a 48 month loan and interest rate of 8.25 percent, monthly payments would run around $540 a month. And that doesn't count insurance, or the spike in operating expenses that will come once oil resumes its rise in price. (This is one reason why a car-dependent society is such a bad idea.)

Housing, health and transportation costs are just three examples of how people like my acquaintances are being squeezed by a predatory economic system whose masters seek to make all necessities as expensive as possible in order to maintain their profit margins. But that system has nibbled away at the working class in other ways, namely, in the stagnation or actual decline in worker wages even as worker productivity rose in the period from the 1970's until now. (Sources: http://monthlyreview.org/0607wkt.htm; http://washingtonpolicywatch.org/2009/03/12/looking-past-the-banking-crisis-stagnating-real-wages-part-1-of-3/ and http://www.dailykos.com/story/2009/5/21/733001/-No-Sustained-Economic-Growth-without-Real-Wage-Growth, to name just a few.)

The average salary for white collar workers in the U.S. in 2005 was $39,629 according to the Bureau of Labor Statistics. However, many people with technical degrees earned significantly more than this. (Of course, many of their jobs are now vanishing.) If we assume that my friend has a bachelors degree from an accredited university, he can expect to earn a million dollars more over his lifetime than someone with only a high-school degree – at least, that's what most advocates of higher education say. But what with the inflation of tuition costs over the years, at least one source (http://www.aei.org/outlook/100034) claims that this million-dollar figure should really be whittled down to around $120,000. Of course, all depends on what subject your degree is in. If my friend took out student loans to finance his tuition, he's probably still in the hole today. (See also Wikipedia, http://en.wikipedia.org/wiki/College_tuition#Hyperinflation_of_college_costs.) For what it's worth, I don't think my friend has had much post-secondary education.

As the prices of key necessities continue to be artificially inflated while the real earning power of working-class people continues to decline, those ordinary people who continue to rely on the system of the “official” economy begin to resemble children clinging for dear life to a merry-go-round that's spinning faster and faster out of control. Those who fall off or let go are dashed cruelly to the ground, yet to keep hanging on requires all one's time and strength. The merry-go-round is on the verge of breaking, yet those who are still hanging on have no energy left for learning to adapt to life without the merry-go-round. There's very little strength or time left for learning skills like gardening, or for beginning the steps of adaptation to economic collapse. In fact, there's not even time to learn to play the guitar.

Citizen Media - The Stories We Must Tell

We come on the ship they call the Mayflower,

we come on the ship that sailed the moon;

We come in the age's most uncertain hours

and sing an American tune...

– Paul Simon, American Tune

As I have said in previous posts, corporate media is a tool of the present masters (owners of the major pieces) of our economic and political systems, and is used by these masters to enforce the present status quo. This is done by telling the story of the rich as if it was the only legitimate story, by marginalizing the stories of the poor, and by suppressing any dissent to the present system. Thus corporate media is unwilling to accurately depict the failings of and threats to the prevailing system, or to state the need for alternatives that threaten the power of the masters of this system.

So we hear of green shoots instead of plain evidence of continued economic collapse; Peak Oil is never discussed; major newspapers write editorials against genuine health care reform; and the threat of man-made climate change is not publicized. When alternatives to the present system are discussed, their discussion in corporate media is frequently in disparaging tones (as when describing those “frugal doomer/survivalist loonies riding bicycles and raising chickens!!!”). When the rich prosper (as in stock prices rising due to corporations cutting costs and returning dividends), this is held up as a sign that the economy is recovering – even though hundreds of thousands of ordinary people are still being thrown out of work each month.

When left to itself, corporate media ignores the stories of the exploitation of the poor by the rich. When the poor rise up against such exploitation, their action is either not covered at all, or is too frequently called “agitation,” “terrorism,” “militancy,” or some other derogatory term. Corporate media portrays certain segments of humanity unsympathetically in order to legitimize the robbing, exploitation and general mistreatment of these segments by the rich masters of First World society.

Citizen media is a countermeasure to all of this, a weapon by which the poor and powerless can defend themselves. Citizen media is the means by which we can tell our story when no one else will. Here are some stories we should be telling:

• The general stories of our communities and of the people in them. This is especially important for poor people and minority neighborhoods. When mainstream America sees that we are just as human as the subjects favored by the media, they can't easily oppress us in good conscience. They can't so easily write our neighborhoods off as merely another “high-crime” area or “blight district.” Create a biographical sketch of the people of your place, of their hopes and fears and struggles and humanity.

• The things we are doing to make our communities a better place. This includes not just general betterment, but also steps to make our places resilient in the face of economic collapse and resource constraints. Show the world your care for your place by showing the investment of time and effort that you are putting into your community.

• The actions taken by some of our economic and political masters to break our neighborhoods, destroy our resiliency and exploit us. By publicizing these stories, we make it harder for the big people to get away with what they are doing. Talk especially about the things being done by the big guys (both corporate and governmental) to thwart the things ordinary people are doing to make their communities better and more resilient.

These stories must be told in a format that is of high quality, regularly updated and readily accessible. This will mean hard work for would-be citizen journalists if they want to turn out a quality product. (I can testify that trying to write a quality blog is hard work! It takes a serious investment of time.) But those who rise to such a calling will find that it's quite rewarding. A case in point is the example of Ralph Kennedy and those with him who founded the Fullerton Observer, a local independent paper based in Fullerton, California. The Observer is available both in hard copy and on the Web as a free download. I recently asked Ralph's daughter Sharon Kennedy for some background information on the Observer as well as thoughts on running a community newspaper. Here is her response:

“The Observer was started on a shoe-string by a group of friends after the OC Register bought up the local hometown paper (and 31 others) and turned it into an advertising rag. The friends each had their interest in a certain part of the town such as city hall, police relations, homeless issues, affordable housing, transportation and bike trails, education, keeping some open space, etc. or accomplished other tasks such as pasting up (before computers), driving to the printer, picking up the papers and distributing them.

“Each reported on meetings and happenings around town on their issue and each contributed money to the paper for years before it became self-sustainable. Over the years the paper has had an influence on numerous issues and has made the town of Fullerton, one of the better towns in OC. It also created a sense of community by offering citizens a place to sound out and find others with the same concerns. And since it is read by Fullerton officials, these concerns reached city hall in a different way and built support or opposition which improved our town in one way or another. The paper helps keep officials and institutions accountable to the people of the town.

“The paper also served local entertainment by letting people know what was offered right here in town and local businesses by providing inexpensive ad space so they could offer their services and products. It is a very rewarding all-volunteer community written paper which makes it unique. All towns used to have a hometown newspaper. Another effect of the paper has been to make the OC Register have to create a more adequate version of the Fullerton paper they bought. My father, the founding and longtime editor Ralph Kennedy felt independent newspapers are necessary for a healthy democracy.”

One final note is in order. Citizen media now relies heavily on Web-based tools such as blogs. But we must also begin to look beyond the Web to other means of cheaply and easily broadcasting our stories. This is especially true now that the freedom of the Web in America is coming under increased scrutiny from the United States government (as in the proposed Cybersecurity Act of 2009). Of course, the governments of several other nations, including China and Iran, are already trying to restrict the freedom of Internet communication for their citizens. Therefore we must not put all of our citizen media eggs in one Web basket.

Citizen journalists may therefore need to rely more exclusively on “old-fashioned” means of distribution such as hard-copy community newspapers. But there are other means of sharing electronic media beside the Web – especially with the availability of cheap memory sticks, CD burners, and such. We may see the revival of the “sneakernet,” as described in the following link: http://www.lowtechmagazine.com/2009/02/sneakernet-beats-internet.html.