Monday, December 7, 2009

Truthout Interview With Ralph Nader: "Only the Rich Can Save Us"

Wednesday 14 October 2009
by: Jason Leopold, t r u t h o u t | Video Interview



http://www.truthout.org/1014091

Liberals Are Useless

By Chris Hedges

Posted on Dec 7, 2009
AP / Jens Meyer

Liberals are a useless lot. They talk about peace and do nothing to challenge our permanent war economy. They claim to support the working class, and vote for candidates that glibly defend the North American Free Trade Agreement. They insist they believe in welfare, the right to organize, universal health care and a host of other socially progressive causes, and will not risk stepping out of the mainstream to fight for them. The only talent they seem to possess is the ability to write abject, cloying letters to Barack Obama—as if he reads them—asking the president to come back to his “true” self. This sterile moral posturing, which is not only useless but humiliating, has made America’s liberal class an object of public derision.

I am not disappointed in Obama. I don’t feel betrayed. I don’t wonder when he is going to be Obama. I did not vote for the man. I vote socialist, which in my case meant Ralph Nader, but could have meant Cynthia McKinney. How can an organization with the oxymoronic title Progressives for Obama even exist? Liberal groups like these make political satire obsolete. Obama was and is a brand. He is a product of the Chicago political machine. He has been skillfully packaged as the new face of the corporate state. I don’t dislike Obama—I would much rather listen to him than his smug and venal predecessor—though I expected nothing but a continuation of the corporate rape of the country. And that is what he has delivered.

“You have a tug of war with one side pulling,” Ralph Nader told me when we met Saturday afternoon. “The corporate interests pull on the Democratic Party the way they pull on the Republican Party. If you are a ‘least-worst’ voter you don’t want to disturb John Kerry on the war, so you call off the anti-war demonstrations in 2004. You don’t want to disturb Obama because McCain is worse. And every four years both parties get worse. There is no pull. That is the dilemma of The Nation and The Progressive and other similar publications. There is no breaking point. What is the breaking point? The criminal war of aggression in Iraq? The escalation of the war in Afghanistan? Forty-five thousand people dying a year because they can’t afford health insurance? The hollowing out of communities and sending the jobs to fascist and communist regimes overseas that know how to put the workers in their place? There is no breaking point. And when there is no breaking point you do not have a moral compass.”

I save my anger for our bankrupt liberal intelligentsia of which, sadly, I guess I am a member. Liberals are the defeated, self-absorbed Mouse Man in Dostoevsky’s “Notes From Underground.” They embrace cynicism, a cloak for their cowardice and impotence. They, like Dostoevsky’s depraved character, have come to believe that the “conscious inertia” of the underground surpasses all other forms of existence. They too use inaction and empty moral posturing, not to affect change but to engage in an orgy of self-adulation and self-pity. They too refuse to act or engage with anyone not cowering in the underground. This choice does not satisfy the Mouse Man, as it does not satisfy our liberal class, but neither has the strength to change. The gravest danger we face as a nation is not from the far right, although it may well inherit power, but from a bankrupt liberal class that has lost the will to fight and the moral courage to stand up for what it espouses.

Anyone who says he or she cares about the working class in this country should have walked out on the Democratic Party in 1994 with the passage of NAFTA. And it has only been downhill since. If welfare reform, the 1999 Financial Services Modernization Act, which gutted the 1933 Glass-Steagall Act—designed to prevent the kind of banking crisis we are now undergoing—and the craven decision by the Democratic Congress to continue to fund and expand our imperial wars were not enough to make you revolt, how about the refusal to restore habeas corpus, end torture in our offshore penal colonies, abolish George W. Bush’s secrecy laws or halt the warrantless wiretapping and monitoring of American citizens? The imperial projects and the corporate state have not altered under Obama. The state kills as ruthlessly and indiscriminately in Iraq, Afghanistan and Pakistan as it did under Bush. It steals from the U.S. treasury as rapaciously to enrich the corporate elite. It, too, bows before the conservative Israel lobby, refuses to enact serious environmental or health care reform, regulate Wall Street, end our relationship with private mercenary contractors or stop handing obscene sums of money, some $1 trillion a year, to the military and arms industry. At what point do we stop being a doormat? At what point do we fight back? We may lose if we step outside the mainstream, but at least we will salvage our self-esteem and integrity.

I learned to dislike liberals when I lived in Roxbury, the inner-city in Boston, as a seminary student at Harvard Divinity School. I commuted into Cambridge to hear professors and students talk about empowering people they never met. It was the time of the leftist Sandinista government in Nicaragua. Spending two weeks picking coffee in that country and then coming back and talking about it for the rest of the semester was the best way to “credentialize” yourself as a revolutionary. But few of these “revolutionaries” found the time to spend 20 minutes on the Green Line to see where human beings in their own city were being warehoused little better than animals. They liked the poor, but they did not like the smell of the poor. It was a lesson I never forgot.

I was also at the time a member of the Greater Boston YMCA boxing team. We fought on Saturday nights for $25 in arenas in working-class neighborhoods like Charlestown. My closest friends were construction workers and pot washers. They worked hard. They believed in unions. They wanted a better life, which few of them ever got. We used to run five miles after our nightly training, passing through the Mission Main and Mission Extension Housing Projects, and they would joke, “I hope we get mugged.” They knew precisely what to do with people who abused them. They may not have been liberal, they may not have finished high school, but they were far more grounded than most of those I studied with across the Charles River. They would have felt awkward, and would have been made to feel awkward, at the little gatherings of progressive and liberal intellectuals at Harvard, but you could trust and rely on them.

I went on to spend two decades as a war correspondent. The qualities inherent in good soldiers or Marines, like the qualities I found among those boxers, are qualities I admire—self-sacrifice, courage, the ability to make decisions under stress, the capacity to endure physical discomfort, and a fierce loyalty to those around you, even if it puts you in greater danger. If liberals had even a bit of their fortitude we could have avoided this mess. But they don’t. So here we are again, begging Obama to be Obama. He is Obama. Obama is not the problem. We are.

Chris Hedges, author of “Empire of Illusion: The End of Literacy and the Triumph of Spectacle,” will speak with other anti-war activists at Lafayette Park across the street from the White House at 11 a.m. Dec. 12 in a rally calling for the withdrawal of all American troops from Iraq and Afghanistan.

http://www.truthdig.com/report/item/liberals_are_useless_20091206/

The Physics of Copenhagen: Why "Politics as Usual" May Mean the End of Civilization

Sunday 06 December 2009

by: Bill McKibben | TomDispatch.com

Most political arguments don’t really have a right and a wrong, no matter how passionately they’re argued. They’re about human preferences -- for more health care or lower taxes, for a war to secure some particular end or a peace that leaves some danger intact. On occasion, there are clear-cut moral issues: the rights of minorities or women to a full share in public life, say; but usually even those of us most passionate about human affairs recognize that we’re on one side of a debate, that there are legitimate arguments to the contrary (endless deficits, coat-hanger abortions, a resurgent al-Qaeda). We need people taking strong positions to move issues forward, which is why I’m always ready to carry a placard or sign a petition, but most of us also realize that, sooner or later, we have to come to some sort of compromise.

That’s why standard political operating procedure is to move slowly, taking matters in small bites instead of big gulps. That’s why, from the very beginning, we seemed unlikely to take what I thought was the correct course for our health-care system: a single-payer model like the rest of the world. It was too much change for the country to digest. That’s undoubtedly part of the reason why almost nobody who ran for president supported it, and those who did went nowhere.

Instead, we’re fighting hard over a much less exalted set of reforms that represent a substantial shift, but not a tectonic one. You could -- and I do -- despise the insurance industry and Big Pharma for blocking progress, but they’re part of the game. Doubtless we should change the rules, so they represent a far less dominant part of it. But if that happens, it, too, will undoubtedly occur piece by piece, not all at once.

Moving by increments: it frustrates the hell out of many of us, and sometimes it’s truly disastrous. (I just watched Bill Moyers’ amazing recent broadcast of the LBJ tapes in the run-up to the full-scale escalation of the Vietnam War, where the president and his advisors just kept moving the numbers up a twitch at a time until we were neck deep in the Big Muddy.) Usually, however, incrementalism, whatever you think of it, lends a kind of stability to the conduct of our affairs -- often it has a way of setting the stage for the next move.

We may have to wait years for the next round of health-care reform and, in the meantime, doubtless many people will suffer, but here’s the one thing we know: what we don’t do now doesn’t foreclose future progress. In fact, it may make it more likely -- if, after all, people grow comfortable with the idea of a “public option,” then the next time around the insurance industry won’t be able to make actual, honest-to-God public medicine seem so scary.

Climate Change as Just Another Political Problem

When it comes to global warming, however, this is precisely why we’re headed off a cliff, why the Copenhagen talks that open this week, almost no matter what happens, will be a disaster. Because climate change is not like any other issue we’ve ever dealt with. Because the adversary here is not Republicans, or socialists, or deficits, or taxes, or misogyny, or racism, or any of the problems we normally face -- adversaries that can change over time, or be worn down, or disproved, or cast off. The adversary here is physics.

Physics has set an immutable bottom line on life as we know it on this planet. For two years now, we’ve been aware of just what that bottom line is: the NASA team headed by James Hansen gave it to us first. Any value for carbon dioxide (CO2) in the atmosphere greater than 350 parts per million is not compatible "with the planet on which civilization developed and to which life on earth is adapted.” That bottom line won’t change: above 350 and, sooner or later, the ice caps melt, sea levels rise, hydrological cycles are thrown off kilter, and so on.

And here’s the thing: physics doesn’t just impose a bottom line, it imposes a time limit. This is like no other challenge we face because every year we don’t deal with it, it gets much, much worse, and then, at a certain point, it becomes insoluble -- because, for instance, thawing permafrost in the Arctic releases so much methane into the atmosphere that we’re never able to get back into the safe zone. Even if, at that point, the U.S. Congress and the Chinese Communist Party’s Central Committee were to ban all cars and power plants, it would be too late.

Oh, and the current level of CO2 in the atmosphere is already at 390 parts per million, even as the amount of methane in the atmosphere has been spiking in the last two years. In other words, we’re over the edge already. We’re no longer capable of “preventing” global warming, only (maybe) preventing it on such a large scale that it takes down all our civilizations.

So here’s the thing: When Barack Obama goes to Copenhagen, he will treat global warming as another political problem, offering a promise of something like a 17% cut in our greenhouse gas emissions from their 2005 levels by 2020. This works out to a 4% cut from 1990 levels, the standard baseline for measurement, and yet scientists have calculated that the major industrialized nations need to cut their emissions by 40% to have any hope of getting us on a path back towards safety.

And even that 17% cut may turn out to be far too high a figure for the Senate. Here’s what Senator Jim Webb (a coal-country Democrat) wrote to the president last week: "I would like to express my concern regarding reports that the Administration may believe it has the unilateral power to commit the government of the United States to certain standards that may be agreed in Copenhagen… The phrase 'politically binding' has been used. As you well know from your time in the Senate, only specific legislation agreed upon in the Congress, or a treaty ratified by the Senate, could actually create such a commitment on behalf of our country."

In any case, the Senate has decided that it will not debate any climate-change bill until “the spring,” after health care is settled, and maybe entitlement reform, and perhaps even financial regulation. And awfully close to the next election.

Meanwhile, the Chinese are apparently prepared to offer a 40% reduction in the “energy intensity” of their economy by 2020. In other words, they claim they’ll then be using 40% less energy to make each yuan worth of stuff they ship off to WalMart. Which is better than not doing it, but more or less what the experts think would happen anyway as China’s economy naturally becomes more high-tech and efficient. It’s at best a minor stretch from “business as usual.”

Meanwhile, the Indians almost sacked their environment minister after the newspapers decided he was compromising the national interest by engaging in real negotiations about global warming.

Meanwhile, the Australian opposition last week did sack their leader for being willing to compromise on an already-compromised Emissions Trading Scheme that would have capped carbon -- meaning nothing will pass.

Meanwhile…

A Challenge Unique in History

A new analysis released Thursday by a consortium of European think-tanks shows that the various offers on the table add up to a world in which the atmosphere contains 650 parts per million and the temperature rises an ungodly five degrees Fahrenheit.

What I’m saying is: even the best politicians are treating the problem of climate change as a normal political one, where you halve the distance between various competing interests and do your best to reach some kind of consensus that doesn’t demand too much of anyone, yet reduces the political pressure for a few years -- at which time, of course, you (or possibly someone entirely different) will have to deal with it again.

Obama is doing the same thing with climate change that he did with health care. He’s acting with complete political realism, refusing to make the perfect the enemy of the good (or, really, the better-than-Bush). He’s doing what might make sense in almost any other situation.

Here, unfortunately, the foe is implacable. Implacable foes emerge rarely. The best human analog to the role physics is playing here may be fascism in the middle of the last century. There was no appeasing it, no making a normal political issue out of it. You had to decide to go all in, to transform the industrial base of the country to fight it, to put other things on hold, to demand sacrifice.

Yet it’s all too obvious that we’re not dealing with it that way. The president hasn’t, for instance, been on a nonstop campaign to make everyone realize the danger. When he went to China, he certainly reached some interesting agreements about cooperation on automobile technology, but that’s not the same as seeking a wartime partnership.

Nor is the senate meeting late into the night figuring out how to mobilize our country’s resources and people in the struggle to save our planet. Here’s how Missouri Senator Claire McCaskill summed up the mood: “I don’t think anyone’s excited about doing another really, really big thing that’s really, really hard that makes everybody mad.”

Some of us have been trying hard to open some political space for world leaders to step up to this challenge. We built a worldwide movement at 350.org that managed to pull off the “most widespread day of political action in the planet’s history” (at least according to CNN). In some places, it even sparked the desired result. Ninety-two nations, all poor and vulnerable to the early effects of climate change, have endorsed that radical 350 target.

Some of their leaders, like Mohamed Nasheed, the president of the Maldives, a nation made up of more than a thousand islands in the Indian Ocean, have emerged as tigers, ready to fight. No one would be surprised to see him lead some kind of walkout from the Copenhagen negotiations, since he’s declared over and over that he won’t be party to a “suicide pact” for his low-lying nation; he is, in other words, unwilling to treat global warming as a normal political issue.

We, however, couldn’t get even the most minor player in the Obama administration to come to one of the 2,000 rallies we staged across this country. None of them were interested in jumping into the space we were trying to open. If the U.S. is this willing to treat climate change as politics-as-usual, most of the other major players will simply follow suit.

They'll sign some kind of paper in Denmark -- that became all but certain on Friday night when Obama announced he'd jet in for the meeting's close. European leaders and some environmental groups may then call it a “qualified success,” and on we will go through more years of negotiation. In the meantime, physics will continue to operate, permafrost will continue to thaw, sea ice to melt, drought to spread.

It’s like nothing we’ve ever faced before -- and we’re facing it as if it’s just like everything else. That’s the problem.

Bill McKibben is a scholar in residence at Middlebury College. His The End of Nature, published in 1989, is regarded as the first book for a general audience on global warming. He is a founder of 350.org, a campaign to spread the goal of reducing atmospheric carbon dioxide to 350 parts per million worldwide. He is, most recently, the editor of American Earth: Environmental Writing Since Thoreau (Library of America). His next book will be Eaarth: Making a Life on a Tough New Planet, which will be published in April. To listen to a TomDispatch audio interview with McKibben on President Obama and climate change politics in the U.S., click here.

Copyright 2009 Bill McKibben

http://www.truthout.org/1207095

Revitalizing the Antiwar Movement

Monday 07 December 2009

by: Camillo "Mac" Bica, t r u t h o u t | Op-Ed

With Nobel laureate Barack Obama's announced escalation of the occupation of Afghanistan, even those who believed his rhetoric of hope and change, who supported and voted for him in the last election, have realized at last that his administration represents neither, that the honeymoon is over and patience is no longer a virtue. Consequently, many peace-minded people are looking again to an anti-war movement and finding it somewhat in disarray, perhaps an understatement. If it is truly our intent to revitalize the anti-war movement, we must begin a dialogue to redefine our goals and to re-evaluate and clarify our tactics and strategy. That is, we must become more focused on ending American militarism and imperialism, war and occupation, and we must build a coalition of voices by practicing tolerance and understanding for a diversity of views and opinions.

I think a couple of important conceptual clarifications are necessary. Collective entities, as such, do not exist. Terms such as "movements," "nations," "corporations" etc. are rhetorical devices, referents, which designate a set of individual human beings with varied and diverse points of view, but who share (have in common) the relevant interest and/or belief that characterizes the particular collective in question. Consequently, collective entities lack agenthood or personhood. That is, movements, nations, corporations etc., do not act, individuals do. This is important because unscrupulous people - politicians, corporate executives etc. - have taken advantage of - exploited - this fallacy of reification, i.e., ascribing substance or real existence to mental constructs or concepts in order to shroud themselves within the anonymity of the abstraction, the collective, as a means of diffusing, and thereby avoiding, responsibility or culpability for their actions.

I understand "anti-war" to mean an opposition to and condemnation of war and occupation. An anti-war movement, therefore, designates individuals who share what I will term an "anti-war vision," that is, oppose and seek an end to war and occupation. "Peace," however, is much more encompassing than merely an absence of war. Even Ronald Reagan agreed, though tragically, more in word than in action. "True peace," he told us, "is justice, true peace is freedom. And true peace dictates the recognition of human rights." A peace movement, therefore, designates individuals who, in addition to opposing war and occupation, share what I will term a "peace vision," that is, support what they see as issues of human rights, justice, equality and fairness. A peace vision may be complex and varied and may include such demands as a recognition of gay marriage, a woman's right to choose, the rights of immigrants, perhaps even of advocating a velvet revolution - an end to the oppression and exploitation some see as intrinsic to a capitalist imperialist system. Both movements have their place; both are important. Understanding this distinction is crucial in building a viable anti-war movement, in motivating individuals to join together to end war and occupation.

We are at a crucial juncture in our nation's history, a time of great economic and social upheaval that is made even more precarious by Obama's insistence on continuing the occupation of Iraq, escalating the occupation of Afghanistan and the war in Pakistan. We continue to spend trillions of dollars to kill and to destroy rather than to build, educate and heal. Though we live in the illusion of America's greatness and beneficence, it is clear from our continued militarism and imperialism that we have lost our moral compass and have forfeited any moral authority we may have had in the world. We have become the world's pariah, and there is blood on all our hands. Perhaps, it is already too late; hopefully, it is not. If we are to salvage what remains of our nation and of our integrity, our moral character, we must act and act now to build a viable anti-war movement, to effect change that is far reaching and long lasting. We must foster a groundswell of resistance to a political leadership that, despite its rhetoric, sees war and violence as a substitute for the hard work of diplomacy and the peaceful resolution of differences.

If we are to build a viable anti-war movement, we must seek to unite all individuals who share the anti-war vision, i.e., that war and occupation is immoral, illegal and not in their interest, but yet who may have differences regarding their vision for peace, i.e., whether there is a right of choice or a fetal right to life, whether same sex marriage should be recognized or whether marriage is between a man and a woman, whether capitalism is intrinsically oppressive and must be overthrown or whether we can achieve fairness and justice in spite of its quest for profit. Be clear, I am not, by any means, advocating toleration or concession to "bigotry, misogyny and know-nothing jingoism." That's not what cooperative effort is about. It's about understanding that unanimity of beliefs is an ideal, not a reality. It's about working together with honest and sincere individuals for the betterment of humankind, ending war and occupation and agreeing to disagree about when life begins, the "definition" of marriage, the virtues or vices of capitalism, differences which can and must be discussed, debated and, hopefully, resolved at another time, and in another venue.

But the situation is dire and time is short, so as you continue to work for peace, be aware that if we are to build a viable anti-war movement, we must have understanding and toleration for a diversity of views. We must focus upon what we have in common, rather than on what divides us. We must seek to create an environment in which all sincere people who oppose war and occupation can be accommodated, not alienated. Perhaps, in developing this cooperative effort to resolve common concerns - revitalizing the anti-war movement - we may eventually be better able to engage in meaningful dialogue to resolve, reasonably and rationally, other differences that may divide us. Why not? Isn't this what a peace movement is supposed to be about?

Camillo "Mac" Bica, Ph.D., is a professor of philosophy at the School of Visual Arts in New York City. His focus is in ethics, particularly as it applies to war and warriors. As a veteran recovering from his experiences as a United States Marine Corps Officer during the Vietnam War, he founded, and coordinated for five years, the Veterans Self-Help Initiative, a therapeutic community of veterans suffering from Post-Traumatic Stress Disorder. He is a long-time activist for peace and justice, a member of the Vietnam Veterans Against the War, and the coordinator of the Long Island Chapter of Veterans for Peace. Articles by Dr. Bica have appeared in Cyrano's Journal, The Humanist Magazine, Znet, Truthout.org, Common Dreams, AntiWar.com, Monthly Review Zine, Foreign Policy in Focus, OpEdNews.com, AfterDowningStreet.org and numerous philosophical journals.

http://www.truthout.org/1207096?print

John Gary Maxwell: Health reform from my side of the surgery table

Published: Saturday, December 5, 2009 at 3:30 a.m.
Last Modified: Friday, December 4, 2009 at 9:10 a.m.

Forty years as a surgeon in university and community hospitals gives some authenticity for the following reflections regarding the failings of our health care delivery. Partisan rhetoric has led to shouting matches rather than reasoned choices, while the most fundamental issue in health care reform has yet to be stated: should health care be continued as a profit-driven enterprise? If a problem well-stated is a problem half solved, a clear answer will allow for progress. Here are the some of the problems I have observed:

Health care is already rationed and socialized. We have an unacknowledged disparity between insatiable demand for health care and a capability that cannot meet it. We now find health care rationed on the basis of who will receive care, not on what care will be provided.

Rationing does not apply to emergency care. The unemployed laborer severely injured in a car crash or the farmer who collapses will be given the best care possible. No expense will be spared, all needed consultants will be called, all necessary surgery and definitive care completed.

The patient who presents for planned, scheduled health care gets a different reception. Those needing elective heart surgery, or joint repair, for example, are filtered carefully. Care is rationed by ability to pay.

Insurance coverage, pre-approval, deductible, non-covered services, co-pays, will all be scrutinized. If the patient cannot pay, he or she will either not receive the needed care or will be directed to public facilities or programs that depend heavily on outside or tax-supported funding.

What is certain is that the hospital bill for the well-insured will be sufficiently high to cover expenses generated by poorly insured or uinsured patients.

If "spreading the wealth" is socialization, our system is already socialized, with the "haves" paying for the "have-nots" by a tax on the wealthier group. This explains a $15 aspirin, $10,000 to $15,000 antibiotic bills, and bills for heart surgery of $250,000 or more.

We resist "socialized medicine" from the federal government while oblivious that we have embraced socialized medicine delivered -after profits - by the insurance industry.

A crisis is dangerously imminent in which the "haves" will not be able to pay for the increasingly larger segment of "have-nots."

Rationing of medical care in a non-profit system should be based on society defining what services should be provided, not on restricting care on the basis of income, as in a profit based system.

We currently give priority to crisis care rather than preventive or other types of care. For the best care to the greatest number with the least expense, we should to place preventive care first.

There are inequitable and unreasonable variations in the system. The rates of people having surgical removal of atherosclerotic plaques in the carotid artery, coronary artery bypass or joint replacement operations varies so widely across the nation that it appears that factors other than well-defined indications for the operation are responsible. Could the income generated for hospital, clinics, and ancillary services be a major factor in these widely different rates?

Doctors' pay is equally disparate. Despite similar length of training, extreme variations in amounts paid different doctors exist nation-wide. Six- and seven-figure incomes are common among several specialties, while general surgeons, pediatricians, internists, family practitioners and geriatricians whose education was as arduous - and who may put in more hours - earn far less.

Should limitless profit be the motivation to choose medicine as a career? Inequities in earnings have their origin, in large part, because doctors' pay is based on fee for service.

The more tests performed, the more X-rays ordered, every consultant called, every operation done influences income - directly or indirectly.

The solution to these disparities is one that will not sit well with some of my colleagues: Doctors should be paid a base salary commensurate with their time in education and the responsibilities they carry. Increases in pay should be based on such factors as measurements of quality of care, research and teaching. Highly specialized fields requiring extra education and experience, remaining current in new techniques and extra call on nights, weekends and holidays should be compensated.

Fear of litigation, defensive medicine and end-of-life care contribute to costs. Excessive X-rays, unnecessary consultations and inappropriate antibiotic treatments - all contributors to the cost of medical care - are used to ward off malpractice litigation that can be catastrophic for the doctor. The results of these seldom change treatment or give a better outcome.

End-of-life costs constitute the majority of the total health care dollars spent on each individual. The final 90 days often account for 30 percent to 40 percent of lifetime medical costs. CAT scans, repeated blood tests, ventilator support, dialysis, are often done for fear of litigation or demanded by family members who want "everything" done.

Expense of final days can decimate the family finances without bringing benefit or qualify of life. Decisions made before the stress of imminent death, would allow patient dignity without sacrificing financial solvency.

Tort reform, unequivocally needed, is a small wave in the financial tsunami of our dysfunctional health care delivery.

Continuity of care is disappearing. After work hours, emergency rooms often are the only available caregivers. Care within the hospital is increasingly provided by hospitalists whose entire professional work is inside the hospital. Patient and assigned hospitalist may never have seen one another.

Dr. A will send the patient to the emergency room, where Dr. B will decide on admission. Hospitalist Dr. C provides the care, with the patient discharged to Dr. A's partner, Dr. D, in a system fraught with chances for errors and poor outcomes. All four doctors will send separate bills for their disjointed services.

Other issues: profit, payers and an attitude adjustment for Americans. Rejection of payment claims for any reason, is in the best interest of the insurance company, and claims are often returned for minor or nonexistent deficiencies, denied for pre-existing conditions, alleged improper coding and for failure to receive pre-approval. "Beneficiaries" have their policies cancelled for technicalities when the condition is expensive to treat.

In Great Britain several years ago, a perceptive woman afflicted with a bowel disease requiring a great deal of medical attention, offered me her view: "Americans have no sense of community welfare, no willingness to be discomforted in the least for the greater good of the entire population."

She might have been blunt that well-insured Americans say, "I got mine. To hell with you!"

Unless personal selfishness can be refocused to the common good, health care in the United States will remain with irrational rationing and inappropriate and financially unsustainable socialization by insurance, drug and medical supply industries.

Despite professing Christian love for our neighbor, it has fallen to President Obama to call us to the painful truth: "We are ... the only advanced democracy on Earth -- the only wealthy nation -- that allows (health care) hardship for millions of its people."

The fundamental question in the discussion of improved health care deserves repeating: With its widespread and profound problems, do Americans truly want health care to continue as a profit-driven enterprise?

Retired surgeon John Gary Maxwell is former director of the surgical residency program at New Hanover Regional Medical Center and a professor emeritus at the University of North Carolina and the University of Utah medical schools.

All rights reserved. This copyrighted material may not be re-published without permission. Links are encouraged.


http://www.starnewsonline.com/article/20091205/ARTICLES/912044001/-1/EDITORIAL?Title=John-Gary-Maxwell-Health-reform-from-my-side-of-the-surgery-table&tc=autorefresh