Thorne Webb Dreyer and Sarito Carol Neiman : Bon Voyage, Doctor Keister

Dr. Stephen R. Keister, 1921-2012.
Dr. Stephen R. Keister, 1921-2012:
Bon Voyage, Doctor Keister

By Thorne Webb Dreyer and Sarito Carol Neiman / The Rag Blog / April 12, 2012

It seems the cancer always wins! Tomorrow I go to the Manchester Presbyterian Lodge for final care by Great Lakes Hospice. I am beginning to hear the splash of Old Charon's oars in the waters of the Styx. It ain't all that bad with the memories of all of you fine folks to take along.” – Steve Keister, in a message to his friends and his colleagues at The Rag Blog, February 2, 2012

Dr. Stephen R. Keister left us late Friday night, April 6, 2012, after a long-running bout with prostate cancer. He died in hospice care in his longtime home, Erie, Pennsylvania, at the age of 90.

The cancer may have won but we seriously doubt that Old Charon, the ferryman of Greek mythology (who carried souls of the newly deceased into the world of the dead) succeeded in transporting Steve all the way to Hades.

Steve, ever the philosopher and the reformer, probably recruited the wizened old seaman to his own cause of universal health care and they’re out there now, organizing for a single-payer system in the Afterlife.

Steve Keister, who turned 90 last October, was a retired physician who practiced internal medicine in Erie, PA, from 1950 until 1991, specializing in rheumatology; he was the region’s first practicing rheumatologist.

He attended Duke University where he became interested in the writings and philosophy of Moses ben Miamon, Voltaire, and Sir William Osler. He obtained his M.D. from the University of Maryland and did his postgraduate training at the Mercy Hospital in Pittsburgh and Hamot Medical Center in Erie.

His medical honors were many and after retirement he remained active in scholarship and volunteer work. And Steve found a second passion late in life, dedicating himself to progressive social change, and especially to the cause of universal health care, working with Physicians for a National Health Plan and other activist groups, and writing about health care reform for The Rag Blog.

According to his daughter, Cindy Hepfer, "Steve has always been a voracious reader, continued to play tennis until his 60s when he took up golf instead, and enjoyed having friends in in the evening for drinks and conversation."

And, “after retirement,” Cindy said, “Steve continued his family’s tradition of trying to preserve the tenets of the nation’s Founding Fathers by active membership in People for the American Way, Americans United for the Separation of Church and State, and Amnesty International.”

In a eulogy, Steve's friend Don Swift said that Keister was not only a "gentleman scholar," but that he was also "a mensch, a person of integrity and honor," and that he was "all about trying to heal a broken world."

Fellow Pennsylvania activist and writer Carl Davidson said, “We knew him well here in Western Pennsylvania, especially as an unwavering voice for Medicare for All, and then some. He supported PDA's [Progressive Democrats of America’s] efforts here, but his own views were with the socialist left. Raise a fist and a red rose for him this May Day. He will be missed.”

About her father’s involvement with The Rag Blog, Cindy Hepfer said, “You have certainly given him a mission in these latter years of his life! I thank you for giving Dad a creative outlet and a way to share his goodness and intelligence with others.”

Keister's heavily-researched opinion pieces published by The Rag Blog were rich with personal reference and backed up with facts, figures, and links. They were erudite, yet peppered with wonderful colloquialisms reminiscent of an earlier era, and always filled with quotes and observations from great thinkers, scientists, and philosophers ranging from Rabelais, Pliny the Younger, and Confucius, to Aldous Huxley, Sir William Osler, John Ruskin, and Will Rogers.

And, if you read a column by Dr. Stephen R. Keister, you never had any doubt about where the author stood on the subject.

Though always full of hope personally, Steve became increasingly disillusioned with the medical system in this country and the growing dominance of the pharmaceutical and health insurance companies.

In his writing, he often reflected on the lessons of a lifetime in medicine.

“I entered the practice of medicine in 1950, an idealist, believing in the lesson of the Good Samaritan,” he wrote. “I believed that all persons should be provided with medical care…”

But, “Somewhere in the 1980s medical care, with great planning and premeditation, was usurped by the health insurance cartel in collusion with the pharmaceutical industry. Medicine was changed from a proud profession to a business, and the physician degraded to a ‘health care provider.'"

In his final column for The Rag Blog, entitled “I Cry for My Country,” Dr. Keister wrote:

Having passed the age of 90 I wish that my final days could be days of happiness and good wishes for those about me; however, it appears that fate has ordained otherwise. It would be a great course of satisfaction to see an enlightened, progressive United States as a homeland for my grandchildren. Instead we find a nation that is descending into quasi-feudalism and subservience of the many to the few.

At the time Steve submitted his final column, we at The Rag Blog were aware of his worsening physical condition. We included the following introduction to his piece:

Our dear friend, Dr. Stephen R. Keister, turned 90 on Sunday, October 9. For the last three years Steve has written -- with a unique and singular voice -- dozens of columns about the sad state of our health care system. And in that time he has become the heart and soul of The Rag Blog. He claims this is his last column, but we promise not to hold him to that commitment! We hope he will continue to share his wisdom with us for many months to come.

But we knew it wasn’t likely.


Steve Keister approached death much as he handled life, with vigor, intellectual curiosity, and an open mind. According to his daughter, “He was analyzing the dying process for as long as he could and communicating his thoughts to those around him.”

“He had observed repeatedly to several of us that he was not afraid… and that he always liked to sleep.” Cindy said. "I told him how brave I thought he was and that he shouldn't be afraid to reach out for the sleep that he wasn't afraid of.”

We communicated with Steve during his final weeks and he shared his feelings and observations about the process of dying.


Saying goodbye

"Death is someone you see very clearly with eyes in the center of your heart: eyes that see not by reacting to light, but by reacting to a kind of a chill from within the marrow of your own life." -- Thomas Merton

"The greatest challenge of the day is: how to bring about a revolution of the heart, a revolution which has to start with each one of us?" -- Dorothea Day

How do you say goodbye to a friend? We mean really goodbye -- not “so long, see you later.” Saying goodbye, really, is an opportunity one doesn’t have often or early in life.

When we are young and a friend dies it is usually sudden, unexpected. One day the person is here, the next day that person is gone. And even when we know that death is coming, our culture as a whole does not tend to support the ceremony of saying our goodbyes while that person is still alive. Instead we are supported to remain in denial -- “you can beat this thing, I know you can!”

We are encouraged in so many ways, subtle and not so subtle, to save our goodbyes for when it’s too late for the person who’s leaving to hear them. And by the time we are old enough to see (if we dare to look) the glimmer of our own departure on the horizon, we have no practice in saying goodbye, either as one who is leaving or as one who will remain.

Stephen Keister was a friend. His contributions to The Rag Blog over the past three years have been rooted in a rich lifetime of experience as a physician and proud “secular humanist” and, as such, his insights have been invaluable as we have collectively wrestled with all the implications of the crisis in health care that has plagued the United States now for decades.

His passion for his subject was not abstract or ideological; it was his very life. In his first Rag Blog column, published on Nov. 17, 2008, Dr. Keister was clear where he stood on the question of healthcare reform:

To take the burden off future generations this country must get in step with Western Europe in quality and extent of health care for all. According to the Commonwealth Fund our health care rates 26th in the world and as of Nov. 13 [2008] … U.S. patients, compared to seven other countries, suffer the highest number of medical errors. 44% of chronically ill patients did not get recommended care, fill a prescription, or see a doctor when sick because of costs. 41% of U.S. patients spent more than $1000 in the past year on out of pocket costs, compared to 4% in Britain or 8% in the Netherlands.

We must make sure our elected representatives are not taking baksheesh from the pharmaceutical and insurance industries and support single payer, universal health care devoid of insurance company participation. The nation and your family depend on you not sitting idly on your butt. Call, E-mail, demonstrate!

We lost that battle, obviously. But the war is not yet over, as the sad compromise that became “Obamacare” now finds itself in the Supreme Court. Steve Keister did not live to see the outcome of the current scuffle. But it’s clear, no matter what the outcome, there is still no cause for sitting idly by.


When we heard that it was time to say goodbye to our friend Stephen Keister, we wanted to find a way to honor the occasion. Not to respond with denial, nor to save all our tributes till after he was gone.

So we did what anybody might do if they just found out that a wise and beautiful friend was about to leave for good. We sent him a list of questions, hoping it would offer the opportunity to share what is happening with him now. True to form, he responded both as a scientist and as a humanitarian, the rare combination that has made it such an honor and privilege to publish him over the years.

Here is his response, in his own words. In a sense, this is Steve Keister’s final column. We would like to thank writer and educator -- and Steve's close friend -- Don Swift, for facilitating our final communication with Steve Keister.

Recently I’ve received a request from Thorne Dreyer and his many friends at The Rag Blog, to give him some insight into the situation in which I am involved -- that is, terminal cancer of the prostate, under the care of the good people at the local hospice organization.

Initially, I think we’d better discuss what hospice exactly covers. In my last article in The Rag Blog, entitled “I Cry for My Country,” I refer to several instances of hospices run purely for the financial benefit of the folks in charge. In other words, once again we are faced with the terrible American attitude of money above all else. Therefore, I would suggest that anybody who is interested in legitimate hospice care get a copy of the pamphlet entitled, “When Death Is Near: A Caregiver’s Guide.”

Hospice in the United States is a reasonably new organization, and the hospice in Erie was one of those founded on the basis of charitable giving. Some 25 years ago, Dr. David Dunn, a very capable general surgeon who had spent time in Great Britain during the war, became interested in the hospice movement and spent several months studying the technique as utilized in the U.K. Subsequently he came back to the United States and established a purely volunteer movement, which was soon overburdened, and ultimately taken over by his son, Dr. Geoffrey Dunn at the Great Lakes Hospice, where it remains today.

I became involved in this personally, having been diagnosed with carcinoma of the prostate some 12 years ago. This was treated initially by irradiation and subsequently hormone therapy. Approximately mid-2011, bone scans showed spread of the cancer to the various bones of my body. I tended to ignore this, which was possibly a mistake on my part, because of several factors. At the age of 90 I was enjoying the company of both the Edinboro University retired faculty group, and an 89-year-old lady, who was the best of companions, on the 8th floor of my building.

The question arises, why did I resort to hospice care?

I was not fully aware of the signs of the deteriorating effects of metastatic cancer. I was aware of the fact that we develop painful areas in the bones, but I completely ignored the systemic symptoms of the disease, which are: 1) increased fatigue; one will sleep up to 18 hours a night; 2) complete loss of appetite; one desires nothing, even a glass of milk, for a meal; 3) desire for solitude and lack of interest in things of everyday origin.

These taken together mean something to an alert physician and, happily, Dr. Jeffrey Dunn of hospice stopped by one evening to discuss books, and I discussed my symptoms with him. He said, “Gee, Steve, you’re a candidate for hospice care -- your cancer is spreading.” So the next day I was a hospice patient, and have never regretted it to this day.

Hospice nationally will provide 90 days of care under Medicare. They do not provide inpatient care in a convalescent or nursing home, but otherwise, medicine, equipment, medical care, etc., is provided by the program. I currently am in the Presbyterian Lodge in Erie, and everything is going according to program. I realize I have not long to live, but realize too that I have much to be thankful for throughout my 90 years.

I am also asked how I have rationalized the facing of death, and the question mentions that Socrates, the Zen masters, Jesus, Buddha have all offered alternatives. However, I have somehow avoided these alternatives and looked at this as a purely biological process. We are born in pain, we live largely in pain, and hopefully we can avoid dying in pain.

I’ve been assured by several of the hospice workers that the easiest people to care for are those that are the “secular humanists” who approach each stage of life as a natural event and do not interfere or complicate matters with various philosophical pictures.

While is it true that good hospice care professionals, if possible, provide a role of helping family and friends come to terms with the impending loss of a loved one, some of us are beyond that stage. At the age of 90 we have few living relatives and depend entirely on friends. Happily, I have been blessed with many, many friends in my recent lifetime -- perhaps more so than earlier in my life.

The final question in the submitted list is very interesting and very apropos to the present time. It is: If you could make a new Hippocratic Oath for the 21st century to be given to every student graduating from medical school, what would it be?

This I have given much thought, and do not feel intellectually qualified to answer this at the present time. But I do feel that certain factors should enter into the situation. I do think the philosophy of Dorothea Day and Thomas Merton should play a big part, and within their thinking, we who allegedly feel we are Christians should remember the Sermon on the Mount and the Beatitudes.

In addition to that, from the ethical standpoint we should remember the teachings of two physicians of the last century: Sir William Osler and Dr. W.W.G Maclaclhan of Pittsburgh, both of whom treated people of prominence, the well-known, but at the same time never turned their backs on the poor, the underprivileged or the disabled.

I once again wish to thank my friends in Austin, Texas, my friends in my retired professors' group in Edinboro University, my children, including my daughter Cindy and son-in-law Will (both librarians), and my grandson Jonathan and his wife Alice (both modern musicians with a technique I do not understand but in which apparently they are doing great work). And finally, my dear friend on the eighth floor at 1324 South Shore Drive.

Peace. Peace to all. Thank you.

More of Stephen Keister’s last words can be found in his last columns for the Rag Blog. His final column ended with a challenge for us all to carry on the work of birthing a better world:

I cry for my country, and while asleep I hear in my dreams the mass gatherings of my youth singing, "Arise ye prisoners of starvation, arise thee wretched of the earth, for justice thunders condemnation, a better world's in birth."

Bon voyage, Doctor Keister. You will be missed.

[Thorne Dreyer edits The Rag Blog, hosts Rag Radio, and is a director of the New Journalism Project. He lives in Austin. Sarito Carol Neiman is a freelance editor, author, and actress who lives in Junction, Texas. Together they edited Austin's Sixties underground newspaper, The Rag.]

Find articles by Dr. Stephen R. Keister on The Rag Blog.

Images courtesy of Cindy Hepfer.
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Dr. Stephen R. Keister : I Cry for my Country

I cry for my country:
The state of health care in America

"Laissez-faire, supply-and-demand, -- one begins to be weary of all of that. Leave all to egotism, to ravenous greed of money, of pleasure, of applause; -- it is the gospel of despair." -- Thomas Carlyle, 1843.

By Dr. Stephen R. Keister / The Rag Blog / November 4, 2011

[Happy Birthday Steve Keister!!!

Our dear friend, Dr. Stephen R. Keister, turned 90 on Sunday, October 9. For the last three years Steve has written -- with a unique and singular voice -- dozens of columns about the sad state of our health care system. And in that time he has become the heart and soul of The Rag Blog. He claims this is his last column, but we promise not to hold him to that commitment! We hope he will continue to share his wisdom with us for many months to come.

In the meantime, look for Sarito Carol Neiman's Rag Blog feature article on the life and times of Dr. Stephen R. Keister. Coming soon to a Rag Blog near you!

-- Thorne Dreyer, for everyone at The Rag Blog.]

Having passed the age of 90 I wish that my final days could be days of happiness and good wishes for those about me; however, it appears that fate has ordained otherwise. It would be a great course of satisfaction to see an enlightened, progressive United States as a homeland for my grandchildren. Instead we find a nation that is descending into quasi-feudalism and subservience of the many to the few.

With that in mind, I approach my final column for The Rag Blog with a few observations about medical care in the United States.

Rarely do I watch television as I find it stultifying, by and large, save for a few generally open and informative presentations on MSNBC. I did, however, watch on ABC news report about a day of free medical care at the Los Angeles Coliseum where hundreds of the poor, underprivileged, uninsured stood in line -- many of them all night -- to gain admission to a day of free care provided by volunteers from the L.A. area.

This is my country! This is the nation that spends twice what any other civilized nation spends per capita on health care! This is what the corporate leaders and their political prostitutes have to offer for the coming years! This is what the Republican presidential candidates condone and would promote for the future health care of our country, and for which the current administration has crafted, for political purposes, a faux health care bill, dictated by the insurance consortium and the pharmaceutical industry.

We, in the United States, have the ultimate in health care rationing -- and it's rationing based on one's ability to pay.

Nation of Change featured an article by Noam Levey titled, "U.S. Health Care Falls Further behind Peers, Report Finds." The article, notes that "The U.S. health care system is lagging further and further behind other industrialized countries on major measures of quality, efficiency, and access to care, according to a new report from the nonprofit Commonwealth Fund, a leading health policy foundation." The report in full is available here.

In its fall newsletter, Physicians for a National Health Policy (PNHP) reveals many more facts that surprised me and may surprise you. For instance:

• 60.3 million Americans (19.8%) were uninsured for at least part of 2010, up from 58.5 million people in 2009, according to the National Center for Health Statistics. 48.6 million Americans (16 %) were uninsured at the time of the interview for the 2010 survey, up from 46.3 million people in 2009, with the majority, 35.7 million Americans (11.7% of all Americans), uninsured for more than one year, up from 32.8 million people the previous year, according to an analysis of data from the National Health Interview Survey.


• Nine million working-age Americans -- 57% of people who had health insurance through a job that was lost -- became uninsured between 2008 and 2010, according to a survey by the Commonwealth Fund.


• Health care premiums will rise 8.5% in 2010, according to a PricewatterhouseCoopers survey of 1,700 firms. Employers are offering workers more meager plans in response to rising costs; 17 % of employers surveyed most commonly offered high-deductible health plans to their workers this year, up from 13% in 2010 (Merrill Goozner, The Fiscal Times, 5/18/11).


• The total cost of a health care plan for a family of four covered by a VA Preferred Provider Plan (PPO) in 2011 is estimated to be $19, 393, up 7.3% from 2010, according to Milliman Medical Index. Employer contributions account for 59%, $11,385, of the total, while employees pay 41% of the cost, $8,008. Employees will pay an average of $3,280 in out of pocket costs. (The Milliman Medical Index ).


• U.S.Physicians spend nearly four times more on billing and related overhead each year ($82,975 vs $22,205) per physician than their Canadian counterparts, with U.S. medical practice staff spending over 20.6 hours per week on bureaucratic tasks, compared to just 2.5 hours per physician week under Canada/s single-payer program (Morra et al., "U.S.physicians practices vs Canadians," Health Affairs, 8/11.)


• The nation's five largest for-profit health insurers netted $11.7 billion in profits for 2010, up 51% from 2008, because medical costs grew more slowly than forecast, as insured patients skimped on medical care to avoid costly co-pays and deductables during the severe recession. UnitedHealthcare was the leader in profitability, taking in over $4.6 billion in profits, followed by WellPoint ($2.9 billion) and Aetna ($1.8 billion).


• CEOs at the nation's five largest for-profit insurance companies garnered $55.4 million in compensation in 2010. The top paid was Cigna's David Cordani ($15.2 million), followed by WellPoint's Angela Braly ($13.5 million), United Healthcare's Stephen Hemsley ($10.8 million), Aetna's Mark Bertolini ($8.8 million), and Humana's Michael McAllister ($6.1 million). (Executive Pay-Watch, AFL-CIO, 2011).


• The pharmaceutical industry spent $6.1 billion in 2010 to influence American doctors, and another $4 billion on direct to consumer advertising, according to IMS Health.

And then there's hospice care:

• For-profit hospices are expanding rapidly and may be cherry-picking the most profitable patients, according to a recent study. The number of for-profit hospices increased from 725 in 2000 to 1,600 in 2007, while the number of nonprofit hospices remained stable at 1,205 in 2007. Overall, 52% of facilities are for profit, 35% are non-profit, and 13% are government owned.


• Hospice care is funded by Medicare on a per-diem basis, with a fixed rate ($143 in 2010) paid to providers for each day a patient is in a facility. Because the first and last days of care are more expensive, to provide, longer care generates higher profit. The study found that patients in for-profit facilities averaged a 20-day stay, compared to 16 days in nonprofit centers. (Your author has a question. In view of the fact that hospice care is designed to provide compassionate, painless death with dignity, what is the method of four days longer survival in the for-profit hospice?)


• Hospice care costs for nursing home patients jumped nearly 70% between 2005 and 2009, from $2.5 billion to $4.3 billion, while the number of hospice patients increased by only 40%, according to the Office of the Inspector General. Hospices with a large share of patients in nursing homes were typically for profit and appeared to seek out patients with certain characteristics associated with life expectancy and lower demand for care. The Medicare program paid for-profit hospices more for patients than it paid non-profit and government owned hospices in 2009. For profit hospices received about $12, 600 per patient while nonprofit and government entities received between $8,200 and $9,800 per beneficiary.

One bit of light is the California Medical Association's resolution to legalize marijuana. A tiny bit of encouragement, but a very long way to go.

This old geezer can find nothing to relieve my depression regarding the future of health care in our fair country. The moral decay, the worship of wealth, and the lack of Christian charity appear to create a situation that worsens by the day.

I find no hope within either political party as both are whores to the corporate interests that dominate our society. The sole voices of hope that appear to reach the public in general come from the "99%" movement and Dylan Ratigan's campaign for a constitutional amendment to do away with money in politics.

Unlike in Europe, where the populace has a basic understanding of the existing domestic situation, the average American appears to be entirely moved by nothing but the sloganeering of the political Right.

I cry for my country, and while asleep I hear in my dreams the mass gatherings of my youth singing, "Arise ye prisoners of starvation, arise thee wretched of the earth, for justice thunders condemnation, a better world's in birth."

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

Graphic from The New York Times.

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Dr. Stephen R. Keister : Approaching 90, I Despair for my Country

Image from Free Health Care News.
As I approach my 90th year:
I despair for the state of my country
(and its corrupted health care system)

I look at the Republican 'debates' and wonder, where did we -- as a supposedly enlightened society -- dig up this bunch of morons?

Dr. Stephen R.Keister / The Rag Blog / September 21, 2011

I have come a long way in this world as I anticipate my 90th birthday on October 9. In those many years I have experienced periods of contentment and periods of unhappiness. But never have I seen my country so fraught with danger and despair. Never have I seen such nihilism and cruelty expressed in public view.

The response of the audience to Texas Gov. Rick Perry's pride in multiple executions confirms a nagging feeling I've had for many years that a great percentage of the American public would revel in public executions: public hangings, beheadings, or even hanging, drawing, and quartering. Sometimes it seems like we're descending into the kind of society that would accept a leader along the lines of Vlad The Impaler or Ivan The Terrible.

Yet, paradoxically, it is many of these folks who adhere to "the right to life" concept, idealizing the fetus but not giving a tinker's damn about the children we bomb in Iraq, Afghanistan, or Pakistan, or the infants in this nation who die due to lack of medical care or from malnutrition.

I entered the practice of medicine in 1950, an idealist, believing in the lesson of the Good Samaritan. I believed that all persons should be provided with medical care as was done at the great middle age hospitals in Europe, founded by orders of Sisters who turned away no one from their doors.

For some 30 years my idealism was validated, as no one in our area went without medical care. Those who could not pay were provided for at free clinics sponsored by the nonprofit hospitals, and each of us on the staff of those hospitals took care of, with help of an intern or resident, some 20-30 indigent inpatients. In our private offices money was never an issue until the patient was ready to leave and make a subsequent appointment, when our secretary would ask, "Do you want to pay now or shall we send you a bill?"

Somewhere in the 1980s medical care, with great planning and premeditation, was usurped by the health insurance cartel in collusion with the pharmaceutical industry. Medicine was changed from a proud profession to a business, and the physician degraded to a "health care provider.”

Now when one enters any medical facility the first question asked by the receptionist involves the patient’s manner of payment: "May I see your insurance card?” Instead of an initial hour-long interview with the physician, one is quizzed by a PA, followed by a cursory visit with the doctor. Multiple tests are frequently ordered when a detailed initial interview would have sufficed, and more often than not the patient leaves the office with many unanswered questions.

To add to the immorality of our system we have some 40 million citizens without medical care because they are unable to buy insurance. Yet, this is countenanced by those who claim allegiance to the Christian Right -- a group that appears to be as oblivious to the Sermon on the Mount and the Beatitudes as to the Book of Matthew.

I watch the Tea Baggers docilely follow the propaganda of the billionaire Koch Brothers and propose elimination or substantial modification of Social Security and Medicare, under the illusion that these programs are undermining the national budget -- when indeed these social safety nets are not paid out of the national budget (as are our ongoing wars which are never mentioned), but out of the Social Security trust and Medicare funds that we have all contributed to through wage taxes during our working years.

Now the Republicans would take advantage of a naive public and further drive us into the health care status of a third-world nation. We already rate 26th in the world in health care quality and delivery.

Never mind that the scions of the political Right lie to the people of the United States, with their claims that the Europeans and Canadians have "Socialized Medicine," which is absolutely untrue. The only Western nation with something like socialized medicine is the U.K. and the present Tory Government is trying madly to privatize same in spite of united opposition from physicians, nurses, and other health care professionals. Both the public and health care providers have been generally happy with the health care system conceived and instituted by the conservative Winston Churchill.

I am at the stage of life where I hear the faint splash of old Charon's oars as his barge moves up the Styx, so I have great interest in the hospice movement. Hospice was introduced to the Erie, Pennsylvania area, where I live, by Dr. David Dunn who had studied in depth the well-established British hospice system. The Great Lakes Hospice and V.N.A. Hospices are outstanding, caring, efficient, volunteer organizations.

Now, as with nearly everything, corporate for profit hospice movements have appeared on the scene to feed off of Medicare payments. Several of these organizations, not driven by humanitarian idealism but by corporate greed, have been cited by the Medicare watchdogs for their part in bleeding the Medicare trust fund.

We should all investigate hospice care well before the need arises, just as we should arrange advance directives, and make certain that we will be dealing with a local organization driven by compassion and caring and not by corporate profit. Ideally, we should consider a version of the Swiss Dignitas; however, this would be a pipe dream considering the influence the "religious" element has in the corporate-driven U.S. society.

The June 2011 issue of Forbes has a first-rate article by Rick Ungar entitled "The Coming Crash of the American Health Care System." A few dedicated folks within the profession are still continuing the fight for a decent, affordable health care system in our country, groups like Physicians for a National Health Program and National Nurses United, but the average elected politician turns a blind eye to the situation.

If health care is a priority while you are still young, head for Canada where the health care system, founded by the late Tommy Douglas, is still appreciated by the vast majority of Canadians, or learn French and move to France, which has the top-rated health care system in the world.

Sidney Wolfe, M.D. points out in Public Citizen that our mental health treatment system has returned to a level of the 19th century. No longer are there decent mental hospitals available, but the mentally ill are confined to penal institutions as they were in Dickinsonian times. Over the past two decades, as state psychiatric hospitals have shut down, many with schizophrenia and bipolar disease have been left to wander the streets untreated.

The number with mental illness in our penal facilities has increased 20% since 2000. As early as 2006 the U.S. Department of Justice reported that 24% of inmates in county jails and 15% of inmates in state prisons were psychotic. Under these circumstances how do these folks get treatment? When have you last heard about this problem on a TV news program? Where are our values? Where is our moral backbone?

As the drumbeat of ill news and deception continues, why aren’t we told the truth about the cost to Medicare of Medicare Part D, or the fleecing of the trust fund by Medicare Advantage Plans? The American public gets less and less information about what really matters as the Republicans distract us from the everyday issues relevant to our lives and feed us drivel about the "national debt."

Joseph Goebbels was a piker compared to the propagandists now feeding pure and simple bull to the uninformed, unsophisticated American people. I look at the Republican "debates" and wonder, where did we -- as a supposedly enlightened society -- dig up this bunch of morons?

I would urge all my readers to follow ProPublica’s ongoing investigation into the collusion between the drug manufacturers and many of the physicians in the current medical community -- physicians who, in true American manner, place wealth and income above patient care, ethics, and duty.

A final word of advice. Disregard all pharmaceutical ads on TV -- and there are hundreds -- and just hope your physician is conscientious enough to prescribe what you need at the least cost rather than shill for the drug manufacturers.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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Dr. Stephen R. Keister : America and the Big Lie

Art from Macho Response.
Sold down the river:
America and the big lie

By Dr. Stephen R. Keister / The Rag Blog / August 17, 2011

"Tell big lies. Do not qualify or concede a point, no matter how wrong you may be. Do not hesitate or stop for reservations. The masses are always more easily corrupted in the deeper strata of their emotional natures than consciously, and thus fall victims of the big lie rather than the small lie, since they themselves often tell small lies but would be ashamed to resort to large scale falsehoods." -- Adolph Hitler, Mein Kampf.

Since 1987, Physicians for a National Health Program has been working to bring about reasonable health care reform in the United States. The following comes from the August 10, 2011 online edition of the PNHP Newsletter:

These are challenging times for advocates of single payer health reform, we think you'll agree. Even as PNHP members vigorously celebrate the 48th anniversary of Medicare in opinion pieces, letters to the editor, blogs and even on radio stations across the nation, noting the program's merits and utility as a model for a universal, cost-effective single-payer system, Congress and the White House set up a "deficit reduction" process that will likely result in serious cuts in the program -- with deeper cuts down the road.

The Budget Control Act, signed by President Obama last week, calls for an automatic 2% reduction in Medicare in the event that a newly created "super committee" of six Democrats and six Republicans can't agree on a wider package amounting to at least $1.5 trillion in cuts in federal spending. This super committee can also recommend cuts to Medicaid and Social Security, among other programs.

The Republicans on this panel are unbending hardliners and one of the Senate’s Democratic appointees, Max Baucus, has voted with the Republicans on many occasions. He supported the Bush tax cuts for the wealthy and was the driving force, with an advisor from the insurance industry, in creating the faux Obama health care bill.

Wendell Potter offers an in-depth look at the Affordable Care Act as part of The Nation's series on the American Legislative Exchange Council ("ALEC Exposed"). As we may recall, a very reasonable version of universal health care emerged from the House of Representatives but never was discussed by the Senate. The White House had carried out secret negotiations with the Health Insurance cartel and PhARMA. The prime framing of the final plan came from the Senate Finance Committee under Sen. Baucus.

Mr. Potter points out that there were advance agreements with the insurance industry regarding this legislation, as follows:

1. Keeping single-payer off the table;
2. Requiring all Americans not eligible for an existing federal program to buy coverage from a private insurance company;
3. Excluding the possibility of a government-run alternative (a "public option" that would compete with private insurers);
4. Making sure that the reform law would be implemented primarily at the state level, to keep the federal government from assuming any significant new oversight of private insurers’ business practices; and
5. Keeping any new regulations and consumer protections to a minimum.

There was nothing in the legislation dealing with cost control and no restrictions were placed on "deductibles" or co-insurance.

I would also direct you to the following that appeared on Talking Points Memo:

Last week, Congressional Democrats were blindsided by newly confirmed Defense Secretary Leon Panetta, who basically nixed any further cuts to military spending, and demanded that lawmakers trim from programs like Medicare and raise taxes to reduce future deficits. Republicans on the new Super Committee are expected to seize on Panetta's remarks to push for another deficit deal that comes exclusively from entitlement cuts.

As a 90-year-old retired physician, I am extremely depressed by the unfolding developments in this country and the apparent lack of concern by the American public as they are sold down the river by the politicians -- as the political establishment pays homage to the relatively few Tea Party members of Congress who now control the agenda.

I have just read Erik Larson's excellent book, In The Garden of Beasts. Mr. Larson points to a cultural change that happened in Germany in 1933. He writes:

Beneath the surface… Germany had undergone a rapid and sweeping revolution that reached deep into the fabric of daily life. It had occurred quietly and largely out of easy view. At the core was a government campaign called Gleichschaltung -- meaning "Coordination" -- to bring citizens, government ministries, universities and cultural and social institutions in line with Nazi beliefs and attitudes.

"Coordination" occurred with astonishing speed, even in sectors of life not targeted by specific laws, as Germans willingly placed themselves under the sway of Nazi rule, a phenomenon that became known as Selbstgleichschaltung, or "self-coordination.” Change came to Germany so quickly and across such a wide front that German citizens who left the country for business or travel returned to find everything about them altered, as if they were characters in a horror movie who came back to find people who once were their friends, clients, patients, and customers have become different in ways hard to discern.

Now, with the help of the mainstream media, the American people appear to be accepting the current situation without a single cry of anguish or pain. We remain silent -- unlike our British cousins, who are taking to the streets in response to a similar assault on the middle and lower classes under David Cameron's right wing government.

Do not believe that the cause of the furor in the U.K. is simple vandalism; the unrest is the result of the government’s slashing of programs for the middle class, the minorities, the elderly, and the chronically deprived, accentuated by a serious lack of opportunity for the country's youth, and the decline in health care. All that has ignited the flame. Our collective psyche in the United States will never permit this to happen and should it ever do so there is always NORTHCOM (the United States Northern Command) waiting in the wings.

I am also alarmed by the attitude of my fellow educated progressives, who -- despite the quite obvious successes of the Tea Baggers in Congress, especially on the recent budget resolution bill -- tend to demean these folks as a gaggle of ignorant troublemakers who will have no long term impact on the nation.

I would call attention to a group that formed in Germany in the 1920s who were ridiculed by the establishment. This group included a wholesale merchant, a second rate Russian architect, a pornographer, a drunken dramatist, a locksmith, a broken down professional soldier, a second rate journalist, a transport pilot, a chicken farmer, and a paperhanger.*

In 1933 these folks asserted themselves quite loudly by confining their critics, largely intellectuals and Social Democrats, to an institution south of Munich. The camp, supervised by the previously mentioned chicken farmer, was known as Dachau. It was not yet a concentration camp for Jews. And, oh yes, the paperhanger would gain even further prominence!

And these folks -- as do our politicians today -- had their corporate sponsors: Emil Kirdorf, the coal baron; Fritz Thyssen, head of the steel trust; Georg von Schnitzel of I.G. Farben; Carl Beckstein the piano manufacturer; Alfred Krupp of the munitions industry, and many, many bankers.

*For those interested, the Germans I was referring to above were, in order, Rudolph Hess, Alfred Rosenberg, Julius Streiker, Dietrich Eckard, Anton Drexler, Ernst Roehm, Joseph Goebbels, Herman Goering, Heinrich Himmler, and Adolph Hitler.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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Dr. Stephen R. Keister : Sick of Being Spoon-Fed the News

Cartoon by Don Addis / Quick Take.
Spoon-feeding the news:
Where's our independent press?

By Dr. Stephen R. Keister / The Rag Blog / July 27, 2011

In his novel Sidetracked, Henning Mankkel quotes a retired journalist:

There are two kinds of reporters. The first kind digs in the ground for the truth. He stands down in the hole shoveling out dirt. But up on top there's another man, shoveling the dirt back in. There's always a duel going on between these two. The fourth estate's eternal test of strength for dominance. Some journalists want to expose and reveal things, others run errands for those in power and help conceal what's really happening.

We here make note of the prior dismissal of Keith Olbermann and the recent firing of Cenk Uygur from our only "liberal" television outlet, MSNBC.

When I consider the lack of valid, intelligent information currently available to the American public it would seem that the dirt is being replaced in the hole much more rapidly than the honest, dedicated journalist can dig it out.

I thank my lucky stars for The Nation, The Progressive, and our own Rag Blog and similar credible online news sources.

I am reminded of the remarks made by John Swinton one night in 1880. Swinton, the former chief of staff of The New York Times, continued to write an occasional column but had abandoned full-time editorial work to become active in the labor movement. At a press banquet someone who understood neither the press nor Swinton offered a toast to the independent press. As quoted in Labor's Untold Story by Richard O. Morais, Swinton, outraged, replied:

There is no such thing, at this date of the world's history, in America, as an independent press. You know it and I know it.

There is not one of you who dares to write your honest opinions, and if you did, you know beforehand that it would never appear in print. I am paid weekly for keeping my honest opinion out of the papers that I am connected with. Others of you are paid similar salaries for similar things, and any of you who would be so foolish as to write honest opinions would be out on the streets looking for another job. If I allowed my honest opinions to appear in one issue of my paper, before 24 hours my occupation would be gone.

The business of the journalist is to destroy the truth, to lie outright, to pervert, to vilify, to fawn at the feet of mammon, and to sell his country and his race for his daily bread. You know it and I know it, and what folly is this toasting an independent press?

We are the tools and the vassals of rich men behind the scenes. We are the jumping jacks, they pull the strings and we dance. Our talents, our possibilities and our lives are all the property of other men. We are intellectual prostitutes.

Some of us have fought a dedicated fight for serious health care reform in the United States, but I note in various polls that this issue has been relegated to approximately fifth place in the public's interest. Of prime concern, some 80% of the public is interested in the lack of employment and, in my opinion, rightfully so. However, our chief executive and the dolts in Congress (save for a few compassionate thinking souls) are involved in theatrics that accomplish nothing for our citizens or for the welfare of the country at large.

The press, meanwhile, is consumed with the dubious presidential commission on debt reduction, the suggestions of the "Gang of Six" (three conservative Republicans, two blue-dog Democrats and Sen. Durbin), as well as numerous interviews with totally out of touch "Tea Bag" freshman congressmen -- and various Wall Street characters who are presented to the public as "economists."

The mainstream media largely ignores the efforts in several states to fix elections through such means as requiring photo identification cards and widespread redistricting (read: gerrymandering). Little note is made of the growing layoffs of municipal employees, and the fact that many of the 20% unemployed are losing their unemployment insurance and health care benefits.

There has been minimal attention paid to the punitive anti-abortion legislation being passed in many states, returning us, unhappily -- and irrevocably, I'm afraid -- to the era of "back-alley" abortion which I witnessed in my days as a resident physician -- when I watched young women die a horrible death of gas gangrene sepsis.

We hear that "entitlement” programs are the cause of the national deficit, a claim that ignores the entire history of Social Security and Medicare as traditional off-budget items, to be paid for out of a specific "lockbox" fund, paid for by every worker's employment tax which he/she paid for with a lifetime of labor.

No mention is made of the fact that successive presidents have raided that fund, set aside for entitlement programs, to pay for ongoing, unending wars, and for creating a large surplus of needless military hardware, and who have replaced the “lockbox” funds with government bonds, hence making the social programs part of the general budget.

And we find in the mainstream news media little or no detailed analysis of the cause of our military adventurism and its cost to the average American. We are conned with cries of "terrorism" and made to feel unpatriotic (and thus not to be counted among the “exceptional” American people) if we question the Washington establishment.

I would wager that nine out of 10 Americans are unaware that we have over 700 foreign military bases, many with 18-hole golf courses. Do we know who acquired the oil resources of Iraq after the large scale fighting ceased, and are we aware of the rich mineral and gem resources being exploited in Afghanistan, as has recently been reported in great detail in Fortune Magazine ("J.P. Morgan's hunt for Afghan gold")?

Has the mainstream media reported on the implications of the defunding of Medicaid as is being pursued by the Republican House of Representatives? Not only do we diminish the health care of our poor, underemployed, and unemployed, but we will also lose the prime support for nursing home care. If we follow the dictates of these imbeciles in Washington, Cleveland and Detroit will, in the not too distant future, look like Calcutta in the 1920s.

There is hope in other lands (read Ezra Klein's article in The American Prospect, entitled "The Health of Nations"). Unhappily our elected representatives have other interests and their self-survival to consider. To hell with the American people; they bend their knees to the great corporations.

Life has it's stresses as I -- with my malignancy -- approach the age of 90; however, never in my lifetime have I seen our nation run by such a group of inept, uneducated, grasping, cruel legislators -- excepting Bernie Sanders, Sherrod Brown, Al Franken, Barbara Boxer, and many of the members of the Progressive Caucus of The House of Representatives. And never have I seen the public-at-large so lacking in notable leaders.

Where are the likes of John L. Lewis, Norman Thomas, Phillip Murray, Henry Wallace, and men and women of courage who will lead the sheep away from the precipice.

I cannot help but visualize the passive German masses of 1932 as I look about our nation today. I see multitudes who will respond in automatic obedience to an authority figure, not as individuals in search of liberty and justice. I fear Hannah Arendt had it correct when she coined the phrase the "banality of evil.”

Finally, on a more cheerful note, happy birthday to Rag Blog editor Thorne Dreyer, who turns 66 on August 1st. You still embody that great generation which spawned SDS, the underground press, the thinkers and concerned citizens of your era.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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Dr. Stephen R. Keister : Poverty and Public Health in America

The picture of poverty in America. Image from Bay View.
Poverty and public health:
The social causes of death in America

By Dr. Stephen R. Keister / The Rag Blog / June 29, 2011

"[The] incredible absolute size and commanding market positions [of a few immense corporations] make them the most exceptional manmade creatures of the twentieth century... In terms of the size of their constituency, volume of receipts and expenditures, effective power, and prestige, they are more akin to nation-states than business enterprises of the classic variety." -- Richard Barber, from the book Friendly Fascism by Bertrand Gross.

These days we are always on the lookout for a bit of encouraging news. But the final analysis of the Vermont health care plan comes as a bitter disappointment. The online organization Single Payer Action on June 21 provided us with the sad news: the much-touted Vermont plan is not single payer, not even close.

It seems that the phrase "single payer" was stripped out during the final negotiations, and the implementation of the legislation is dependent on federal approval. It also appears that agencies in Washington will not grant needed waivers. The bill permits the private insurers to operate in Vermont indefinitely.

ScienceDaily reports on a study done at the Columbia University School of Public Health that brings home once again the great failings of the healthcare system in the United States. The study “found that poverty, low levels of education, poor social support and other social factors contribute about as many deaths in the U.S. as such familiar causes as heart attacks, strokes, and lung cancer.”

The investigators found that approximately 245,000 deaths in the year 2000 could be attributed to low levels of education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual poverty, 119,000 to income inequality, and 39,000 to area-level poverty.

Overall, 4.5% of U.S. deaths were found to be attributable to poverty -- midway between previous estimates of 6% and 2.3%. However, the risks associated with both poverty and low education were higher for individuals ages 25-64 than for those of 65 or older. The authors’ findings for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations.

Meanwhile, our elected representatives continue their budget negotiations in Washington with an eye on further cutting an already inadequate Medicaid program and "revising" Medicare benefits, continuing the downward spiral of health care for the poor, the disabled, our returning servicemen/women, and the emotionally ill.

Happily, there is some galvanizing opposition, as witnessed by a massive protest by National Nurses United in Lafayette Square demanding a tax revenue increase from corporations in order to prevent such cuts in Medicaid and Medicare.

I am encouraged by the rare occasions that a group of dedicated Americans will gather in public to speak up against injustice. But I also wonder about the lack of public militancy against injustice here that we see demonstrated by the citizens in our fellow democracies in Europe, especially in Greece, Spain, France, and the United Kingdom.

It would seem that there is an answer, a disturbing answer, contained in an article by Harriet Fraad, published in Tikkun and distributed by AlterNet. The title: "Why Are Americans Passive as Millions Lose Their Homes, Jobs, Families, and the American Dream?" While Dr. Fraad offers some suggestions, one hopes that they do not come too late.

Noam Chomsky peripherally addressed this matter in a 1995 essay when he wrote:

A final point, something I've written about elsewhere (e.g., in a discussion in Z papers and in the last chapter of Year 501). There has been a striking change in the behavior of the intellectual class in recent years. The left intellectuals who... years ago would have been teaching in working-class schools, writing books like Mathematics for the Million, participating in and speaking for popular organizations, etc., are now largely disengaged from such activities, and although quick to tell us that they are far more radical than thou, they are not to be found, it seems, when there is an obvious and growing need and even explicit request for the work they could do out there in the world of people with live problems and concerns. That's not a small problem. This country right now is in a very strange and ominous state.

People are frightened, angry, disillusioned, skeptical, confused. That's an organizer’s dream... It’s also fertile ground for demagogues and fanatics who can (and, in fact, already do) rally substantial popular support with messages that are not unfamiliar from their predecessors in somewhat similar circumstances. We know where it has led in the past; it could again. There's a huge gap that once was at least partially filled by left intellectuals willing to engage with the general public and their problems. It has ominous implications, in my opinion.

A few bright lights in the darkness: Senator Bernie Sanders is facing down the pharmaceutical industry. He has introduced a bill in the Senate authorizing government expenditures of some $80 billion per year to buy up the patents that were awarded to the drug companies for "carrying out research."

These patents, in essence, provide government-granted patent monopolies, thus providing the pharmaceutical companies the right to price drugs at hundreds of dollars per prescription and sometimes several thousand dollars per prescription in the United States.

The money would come from a tax on public and private insurers. The savings from lower-cost drugs would immediately repay more than 100 per cent of the tax.

The country is projected to spend almost $300 billion on prescription drugs this year. Prices would fall to roughly one-tenth the amount in the absence of patent monopolies, leading to a savings of more than $250,000 billion. The savings on lower drug prices should easily exceed the size of the tax, leaving a substantial net reduction in costs to the government and private insurers. For more details about the legislation, see "The Drug Market Scam" by Dean Baker on AlterNet.

The other side of the coin involves a decision by the Supreme Court on June 23, 2011, freeing the generic drug makers from providing consumers with the specific dangers of using a drug. The court, at the same time, gave the pharmaceutical industry access to prescriptions written by physicians for their patients. So much for “patient-physician confidentiality”!

The other bit of good news came in a June 16 New York Times op-ed by President Jimmy Carter, when he joined the chorus of those asking the government to call off the Global War on Drugs. Thus he added his voice to those of Richard Branson, George Shultz, and Paul Volker. President Carter pointed out that this legislation has increased our prison population from 500,000 people in 1980 to 2.3 million in 2009. The increase mostly is for crimes that are non-violent and related to drug possession. There are 743 people in prison for every 100,000 Americans, a higher proportion than in any other country and seven times as great as in Europe. Some 7.2 million people are either in prison, on probation, or on parole -- more than 3% of all American adults.

The cost? California in 1980 spent 10% of the state's budget on higher education and 3% on prisons. In 2010, almost 11% went to prisons and only 7.5% to higher education.

Of course, the fight for enlightened drug policy, as seen in most European nations, will be fought tooth and nail by those who are financially rewarded by the so-called war on drugs — the crime cartels and those receiving baksheesh from the criminal enterprises (corrupt law enforcement officers, politicians, judges, and the operators of our uniquely American private prisons).

One final personal thought: The Republicans keep repeating the mantra that if we increase the taxes on the wealthy, they will not have the funds to create jobs. Of course, this is pure and simple poppycock. Their wealth is not used to produce employment. In the autumn of 2008 at the time of the financial crash, I was talking to a Swiss banker who works for a typical big Swiss bank. In the autumn of 2008, he said, the bank’s below-street-level gold vault, encased in concrete, cracked open under the weight of the gold bullion being shipped in from the U.S.A.

Create jobs!?! Maybe for Swiss concrete workers...

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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Dr. Stephen R. Keister : Saving Granny from Vouchercare

Political cartoon by Nick Anderson / Houston Chronicle.
Unkindest cut of all:
Saving Granny from Vouchercare

By Dr. Stephen R. Keister / The Rag Blog / June 15, 2011

"Avarice has so seized upon mankind that their wealth seems rather to possess them than they possess their wealth." -- Pliny the Younger, Letters, IX, c. 110.

It would appear that the American media, including the so-called "liberal" media, have lost their way among the mundane and the meaningless. Even the "progressive" commentators on MSNBC have become so enamored of Anthony Weiner's indiscretions and Sarah Palin's travels that little else of import has been reported to the American public.

Little of economic interest is discussed in a meaningful way, virtually no mention is made of the worsening unemployment situation, the increasing numbers of those without medical insurance, and nothing, absolutely nothing, about the China-Pakistan mutual defense treaty reported on by Paul Craig Roberts.

One can find little hope in a culture of fragmentation as our news organizations contribute to the further dumbing down of our citizens. In this atmosphere we must tolerate continuous reporting on the likely Republican presidential candidates, including their physical presence on the Sunday morning talk shows. Which brings to my mind H.L. Mencken's comment:

As democracy is perfected, the Office of President represents more and more closely the inner soul of the people. On some great and glorious day the plain folks of the land will reach their heart's desire at last and the White House will be adorned by a downright moron.

In my June 1 article on The Rag Blog I expressed concern about a full-fledged counterattack on the Democratic commitment to preserve Medicare in its present form. The deluge of misinformation, obfuscation, and pure fabrication has already begun.

Already the standard conservative think tanks -- the Cato Institute, Hoover Institute, Hudson Institute, American Enterprise Institute, and Americans For Prosperity -- have sped up the flow of trash through newly formed on-line "organizations” like the Institute for Policy Innovation, Heartland Institute, Social Security Institute, and the 912 Super Seniors organization.

Because of the lack of transparency we remain uninformed about who funds these organizations, but one might assume that these groups include the Koch Brothers, the DeVos Family, the Prince Family, and the Waltons of Walmart.

All this proceeds as the health insurers are making record profits and as many citizens are forced to postpone care (as reported in The New York Times), and as corporations keep shifting health care costs to their workers (as Roger Bybee reported at In These Times), and as the death rate among the uninsured remains around 45,000 a year. I would give CNN some credit for reporting that the U.S. has the second worst newborn death rate in the modern world.

Paul Krugman reports in a New York Times op-ed that medicare is sustainable. (Also read his piece entitled "Vouchercare Is Not Medicare.") Even the suggestion of raising the retirement ago for Medicare would disadvantage the poor as pointed out by Kevin Drum in Mother Jones.

We noted in our last presentation on The Rag Blog that the opponents of Medicare, which date as far back as the Truman Administration, will try their utmost to confuse the elderly public about the necessity of cuts in government subsidization of Medicare Advantage with cuts in the Medicare Trust Fund.

Many folks who have Medicare Advantage believe they are on Medicare and are not aware that they have private insurance. I would point out that there are various "Medicare Advantage" plans, plans administered by multiple insurance companies, and not by the Medicare Administration, although several insurance companies have recently dropped their plans because of insufficient profits.

There are many Medicare Advantage plans, for which the subscriber is charged variable amounts relative to the benefits provided. To review, we have:

1. Medicare HMOs, which require the subscriber to use network providers in all cases except in emergency situations;
2. Medicare HMO-POS, which provide a “point of service” option adding a little freedom to a traditional HMO as one can pay more for limited outside the network coverage;
3. Medicare PPO, which are network-based plans that allow you to go out of network for an additional amount of cost sharing; and
4. Medicare PFFS, which are private fee-for-service plans that allow you to use any provider that accepts Medicare assignment as long as the provider will also accept the plan payment terms and conditions.
   

Some of these plans, at an extra cost, may include certain dental care, and hearing and vision care, but with, of course, specified limits.

There is very valuable information available to the voting public here. It outlines the hazards to the elderly and poor if there is compromise by the Democratic leadership in specific Congressional districts. For instance, in my Congressional district, the Third District of Pennsylvania, the Ryan plan would increase prescription drug costs for 13,000 Medicare beneficiaries, deny 460,000 individuals aged 54 and younger access to Medicare's guaranteed advantage, and increase the out-of-pocket costs of health coverage by over $6,000 per year in 2022 and by $12,000 per year in 2032 for the 107,000 individuals in the district who are between the ages of 44 and 54.

The good news is that the Vermont legislature has passed single-payer health care, and the bill has been signed by the governor. The federal health insurance law would not allow Vermont to enact single payer until 2017; but Vermont is asking the administration to grant a waiver so that it can get there faster, by 2014. It is projected that a single payer plan will be 25% cheaper for consumers, businesses, and the government, than the current system of private health insurance, saving about $500 million in just the first year.

Here I would like to once more call your attention to France, which, according to the World Health Organization (WHO), has the best health care in the world. In case you missed it, please read David Hamilton's Rag Blog analysis of the French health care system, written from on the scene in Paris.

One further encouraging observation amid so much very depressing news. Agence France-Presse reports that, according to a group of prominent world leaders, the so-called "war on drugs" has failed, and that decriminalizing marijuana may help curb drug-related violence and social ills.

The commission includes former Brazilian president Fernando Cardoso, former Columbian president Cesar Gaviria, Mexico's former president Ernesto Zedillo, and ex-UN chief Kofi Annan. The report notes that the "global war on drugs has failed, with devastating consequences for individuals and societies around the world."

The conclusion is that purely punitive measures have led to a situation where "the global scale of illegal drug markets -- largely controlled by organized crime -- has grown dramatically." The panel suggests that governments experiment with models of legal regulation of drugs (especially cannabis) to undermine the power of organized crime and safeguard the health and security of their citizens.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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Dr. Stephen R. Keister : Democrats, Medicare, and the 'Jaws of Victory'

Jaws: Leaving an opening for the Republicans.
From the jaws of victory...
The Democrats, Medicare and
the 'winning message'

By Dr. Stephen R. Keister / The Rag Blog / June 1, 2011

"In a country well governed poverty is something to be ashamed of. In a country badly governed wealth is something to be ashamed of." -- Confucius, Analects VIII, c.500 B.C.

I share the great joy of the progressive community at the Democratic victory in the New York 26th District. All of the pundits appearing on TV news, amid the pharmaceutical commercials ad nauseam, inform us that the Democrats have a "winning message" relative to Medicare come 2012. Pause for a moment, please, and consider how in recent years the Democrats have shown an aptitude for grabbing defeat out of the jaws of victory.”

Yes, maintaining Medicare, and Social Security in their present forms is a very inspiring message. But we have some 17 months ahead for the message to be distorted and overwhelmed by the Republican smear machine. We must recall that we are not dealing with a terribly well informed, cognitively alert population.

I have worked in the area of educating the public about single payer health care for some years. At many a seminar I have been approached by a senior citizen who heatedly informs me, "I don't need government health insurance; I have Medicare! " A similar situation exists among many of the elderly who have Medicare Advantage plans and feel that they are on Medicare.

They do not realize that they were conned by slick salesmanship into giving up their Medicare and signing up for a private insurance plan underwritten by the government at 17% more per year cost to the Medicare Trust Fund.

They are unaware that their "benefits" are set by a profit-making insurance company (why have an insurance industry except to profit the owners and stockholders?) who have by slight-of-hand modified their "benefits" in a manner that appears on superficial examination to provide something better than Medicare per se.

They overlook the deductions, the exclusions, the co-pays, that are not inherent in regular Medicare. I wonder how many Medicare Advantage members will have their way paid to the Mayo Clinic or Johns Hopkins should they wish? My regular Medicare does not restrict my choices. Many Medicare Advantage plans do limit choice save within a specified area or to specified doctors or institutions.

In any event, the current health care legislation progressively reduces the payout from the Medicare Trust Fund to private insurance companies for underwriting the Medicare Advantage plans. Rest assured that the Republican spin machine will play on the naive Medicare Advantage customers with the slogan "the Democrats are going to cut your Medicare."

I would hope that the Democrats will immediately take up this discussion and explain in very simple terms that Medicare Advantage is not Medicare and, indeed, in the long run Medicare Advantage plans will worsen the fluidity of the Medicare Trust.

Granted Medicare expenses, when compared to income from the current wage tax, have become excessive, especially in view of the high unemployment. Medicare costs must be reduced. There are many factors involved, but let us begin with a paragraph from Maggie Mahar's book, Money Driven Medicine:

All too often, hospitals employ some of their most sophisticated tools crudely, even callously, in futile end-of-life care. While roughly 80 percent of Americans hope to die at home, 75 percent end their lives in hospitals or nursing homes. Of these, a third die after 10 days in an ICU. This helps explain why roughly one-quarter of all Medicare dollars are spent during the final year of a patient’s life, thanks in part to the cost of drugs and devices that prolong not just life but pain and suffering.

Perhaps this is a place that rational, fearless, public servants can begin cutting expenses. Here are some suggestions:

1. A presidential panel consisting of medical ethicists, perhaps from Georgetown, Princeton, and The New School, joined by specialists in geriatric medicine and internists or family doctors with university connections (pray not Liberty or Pat Roberts universities) to study a rational end of life program to be incorporated into the Medicare law. Of course the Republicans, who turn away from the 45,000 Americans who die each year sans health care insurance, will shout "death panels!" There are situations, however, where we must turn to rational planning and ignore the cries of the idiots.


2. The wage tax must be extended to all income levels and not be arbitrarily cut off for those with an income of $100,000 or thereabouts.


3. A reasonable additional fee must be enacted for Medicare coverage for those with a joint retirement income over $150,000.


4. There must be subsidized medical school tuition for those candidates who contract to do general practice, internal medicine, or pediatrics for a period of 10 years after graduation, while at the same time fees paid by Medicare for physicians in these specialities must be increased, and the disproportionate fees for those in the "invasive specialities" must be reduced to reasonable levels.


5. The payouts of billions in Medicare funds to the pharmaceutical and insurance industries under Medicare Part D must be curtailed.


6. Medicare fraud must be curtailed and we must take a close look at medical equipment companies that advertise extensively on TV. Are all these gadgets necessary?


7. A rational plan for prescription medicine costs, like they have in Canada and Europe, must be enacted as a part of the Medicare law.


8. The cost of procedures must be reviewed. For instance, a CT Scan in the United States costs more than twice what it would cost in most developed nations, and the same can be said for MRI scans. Of course the reason our scans cost more is that every hospital that possibly can has invested in the equipment in the hopes of increasing their profits.
   

In the meantime another player has appeared on the scene. The hospice industry is now being commercialized. Some 40 years ago the hospice movement began to provide humane end-of-life care to those facing death. This was a movement started by compassionate, dedicated volunteers. Happily, we in Erie, Pennsylvania, have one of the outstanding programs in the country.

Now big business has entered the scene and once again will profit from the dying and their grieving families. Read more about this at the Physicians for a National Health Program website. This article is based on a more detailed study in the Journal of Law, Medicine and Ethics. I felt for many years that the predatory burial industry had stretched the limits of decency in the United States but the advance of corporatism into the realm of dying is beyond my ethical comprehension.

Once again ProPublica is at the forefront in exposing the collusion between the pharmaceutical industry and sections of the medical establishment. We never see generic medications advertised on television -- only brand name products, many of which are remakes of older products. Some we see advertised have had limited clinical trials, like the anti-inflammatory medication that was widely marketed several years ago, but was -- after prolonged clinical testing -- found to be a cause of heart disease and is no longer on the market.

Again quoting Money Driven Medicine:

In 2002, when Families USA, a non-profit health care consumer advocacy group, reviewed the financial reports submitted to the SEC by nine of the largest U.S. based pharmaceutical companies, the group's analysis showed drugmakers investing only $19 billion in R & D, while shelling out some $45 billion for marketing, advertising, and administration. Meanwhile the industry pocketed $31 billion in profits.

Finally, our elderly population must be informed -- and then informed once again -- that the Ryan Plan will do away with Medicare as we know it, with its "vouchers" for buying health insurance from private companies. We must remember that no private insurance company is required to insure any specific individual, and that currently private insurance companies do all in their power not to insure the elderly.

So, if an older person is even able to obtain insurance, in all probability with a large deductible, the voucher will be sent directly to the insurance company. Some estimates suggest that, on the average, the individual will be required to spend $6,000 out-of-pocket to supplement the voucher.

I close with a sobering quote from Mahatma Gandhi: " You assist an evil system most effectively by obeying its orders and decrees." Let us encourage the average citizen not to fall for the blather of the politicians who are in the pay of the corporations.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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