Aug 31, 2008
You can read about him on Wikipedia, but you’d do better to pick up a copy of Tracy Kidder’s book, Mountains Beyond Mountains.
Forty-nine-year-old Paul Farmer is the co-founder, and moving spirit behind Partners in Health (PIH), a worldwide movement dedicated to providing health care for the poor. From hands-on labor as a physician in Haiti, providing care to the poorest citizens of the poorest country in the western hemisphere, Dr. Farmer developed a model for effectively providing care to the poor around the world. PIH now works in Haiti, Peru, Russia, the U.S., Rwanda, Lesotho, Malawi, Mexico, and Guatemala.
Their vision statement is quite remarkable all by itself:
At its root, our mission is both medical and moral. It is based on solidarity, rather than charity alone. When a person in Peru, or Siberia, or rural Haiti falls ill, PIH uses all of the means at our disposal to make them well—from pressuring drug manufacturers, to lobbying policy makers, to providing medical care and social services. Whatever it takes. Just as we would do if a member of our own family—or we ourselves—were ill.From one man living in the mountains of Haiti and bringing aid to sufferers who would otherwise die unnoticed and unmourned, PIH has grown into a $50 million miracle that is showing the world how to deliver world-class health care to its most abject and needy citizens. They do it by working together, forging partnerships with local community health workers, nurses, doctors, administrators, sister organizations, NGOs, local and national governments, and funders.
Aug 30, 2008
Two reports came across our desk on the same day last week, regarding the Medicare Part D drug benefit program, about to enter its fifth year.
One was from the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS), entitled, Lower Medicare Part D Costs Than Expected in 2009. (We guess that’s not ungrammatical, but we know there’s something wrong with that acronym.)
The other was from the Kaiser Family Foundation and is linked below. Their report is entitled, “New Study Examines Impact of ‘Doughnut Hole’ on People Enrolled in Medicare Drug Plans in 2007.”
They must have named the Medicare Part D Drug Plan after the Marquis de Sade. It is the most sadistic imposition of bureaucracy, anxiety, and expense on an aging and ailing population that anyone could possibly come up with.
The first report is, predictably, all pie in the sky. It claims Part D beneficiary satisfaction “remains high” without getting specific, and notes that the basic monthly premium for 2009 will be about $28, a full $14 less than expected at the enactment of the program in 2003.
Segue to the Kaiser report. Here we find that beyond that reasonable monthly premium, Part D also calls for a $275 deductible and, thereafter, a 25 percent co-pay up to the first $2,510 in annual drug costs. Reach that plateau and the fun really begins. Now you’ve arrived at the dreaded Doughnut Hole, a sort of reverse eye of the hurricane, where all is not quiet and where you are on your own for your full prescription drug costs for the next $3,216.
The purpose of the Kaiser report, which was produced in collaboration with Georgetown University and NORC (an apparently orphaned acronym) at the University of Chicago, is to report on the extent and impact of the Doughnut Hole catastrophe in 2007. Then, 26 percent of non-low-income enrollees (low-income people have some protections built in) reached the coverage gap, and 15 percent of them simply stopped taking their medicine. Those who continued saw their monthly out-of-pocket drug expenses soar from $104 (no, not $28) to $196.
So here is what is awaiting us all in our twilight years: A bewildering shopping expedition—with a hefty penalty for dragging our feet—to decide on a plan from a multitude of apples and oranges from which to choose. And thereafter one in four of us can look forward to running out of coverage and paying the full freight on our drugs for, on average, the last third of the year.
Meanwhile, up in the clouds, the Marquis chuckles.
Aug 29, 2008
“My suffering used to be so beautiful. Now it’s just a pain in the ass.” So goes a line from a show we were once in that introduced freshmen to college life.
Kids suffer. We tell them, “Enjoy yourself! It’s the best years of your life.” But they suffer, and we know it. Because we did.
They suffer, to an extent, because suffering is beautiful, in a way, when it is something you can indulge in, and not something which is necessarily visited upon you by outside circumstances. Today, kids are suffering to a great extent because those outside circumstances are impinging upon those “best years” when they ought not to be burdened by the real world.
The Horatio Alger Foundation has just released a report entitled, “The State of Our Nation’s Youth, 2008-2009.” They have been polling teenagers since 1996 on their opinions regarding the nation, their schools, their families, and their own lives, present and to come. The most telling number to report this year is that only 53 percent feel hopeful about their country’s future, down from 75 percent in 2003, the year Bush 2 took us to war in Iraq.
Not surprisingly, 75 percent believe the election will make a large difference for the country although, lacking the franchise, only 12 percent of them pay much attention to the campaigns. The economy and Iraq are the outside worries that are bringing the most pressure to bear on our teens, and the pressure to make good grades and get into the school of their choice is the one that haunts their homework-heavy nights.
In polls like this, the grass is often browner on the other side of the fence. Most of our kids—96 percent—say they are going on to some form of higher education after high school, 93 percent think they will reach their career goals, and 88% are confident about their own futures. Such healthy self-regard may be cause for some relief in the face of their otherwise dim view of the present day.
However, in the face of our persistent militarism; our thralldom to corporate interests that are increasing the gap enormously between the rich and the rest of us; and our apparent inability to work together to confront the educational, environmental, and political challenges that must be overcome if we are to endure, let alone prevail, as a species, I can only echo Hardy’s “Darkling Thrush”:
Aug 28, 2008
If I were King of the Forest, the first thing I would do is to make sure everyone had a clean drink of water when they wanted one. After water comes enough to eat and after that comes an education sufficient to provide each of us with the tools and the maturity to be all that we want to be.
But first comes water, a top priority for just about all life on the planet. And the fact that 2.5 billion people—almost half the population—do not have access to clean water is a disgrace to our species. Over a sixth of the world’s population still defecate in the open—the riskiest sanitation practice of all.
A million and a half children die every year from diarrhoeal diseases, directly attributable to a lack of access to clean water and proper sanitation.
In this International Year of Sanitation, two reports on the state of the world’s water make stark reading.
Aug 27, 2008
In the waning months of the Bush 2 debacle, watch for any number of very quiet efforts on the part of the departing (we hope!) neocons and robber barons to strip the government of its protective prerogatives. We will highlight them here as they come to our attention.
The National Wildlife Federation (NWF) has blown the whistle on a recent effort to gut protections for America’s imperiled wildlife. Says NWF’s Executive Director John Kostyack, “I have been working on the Endangered Species Act for 15 years and have never seen such a sneaky attack ... Do not be fooled when the Administration claims it is merely tweaking the law. The cumulative impact of these changes equals a full blown attack on America’s premier conservation law.”
Among the changes proposed:
Aug 26, 2008
We can’t simply be appalled at what the White House has wrought over the past disastrous eight years. We have to try to laugh at it from time to time.
At least, that’s how the Union of Concerned Scientists sees it. They hosted the 2008 Science Idol Contest for cartoons satirizing the farce the White House would make of science in this country (where 79 percent of the population believe in angels1). See, for instance, Take a Deep Breath and Stifle Yourself.
You can view the top twelve winners and a couple of runners-up at the link below. My favorites? Numbers 5 and 7 and the first runner-up. However, on the whole, this collection, more than anything else, shows just how hard it is to be funny about anti-intellectuals in power.
110/28/05 FOX Poll: More Believe in Heaven Than Hell (Accessed August 21, 2008)
Aug 25, 2008
Insanity: Doing the same thing over and over again and expecting different results. [Albert Einstein (attributed)]Between 1988 and 2006, many states tried doing the same thing over and over again, with each of them consistently coming up with the same disappointing result. They were making the admirable attempt to insure that all of their citizens received adequate medical care when they needed it.
We remain convinced that more radical reforms can simultaneously expand coverage and control costs. A shift from our complex and fragmented payment system to a simple single-payer approach could save about 14.3 percent of total health spending—equivalent to $323 billion in 2007—on reimbursement-driven bureaucracy. Such administrative savings are unattainable with lesser reforms. A nonprofit national health insurance system could also curtail wasteful over-investment in medical technology (e.g., the proliferation of new cardiac care hospitals located near existing ones) and attenuate incentives for unnecessary and even harmful care.What keeps our presidential candidates from taking the position that a solid majority of Americans and a growing number of physicians now favor?1 What keeps our nation from investigating a system the rest of the civilized world has had in place now, in some instances, for well over a generation? Why are our per capita costs for health care per year twice what other countries are spending? Why are over 47 million Americans still uninsured, with the numbers growing rapidly every year?
Aug 24, 2008
These guys at Brookings—it’s just think, think, think, with them. Well, I guess that’s what a think tank is for.
Now they’ve come up with an insurance plan called Pay As You Drive. The plan, outlined in a recent report, entitled “The Impact of Pay-As-You-Drive Auto Insurance in California,”—well, that says it all. In California, according to this report, 20 percent of drivers drive 46 percent of the miles driven. Auto insurance costs are basically the same for everyone, with some variation built in for age, driving record, age of vehicle, etc., without any consideration given to miles driven. If we start considering that important variant in the pricing of auto insurance, 64 percent of households in California would have lower premiums. Not only that, but other benefits would accrue as well:
Aug 23, 2008
As readers are already aware in the short time All Together Now has been online, we are not a fan of privatization. (See Water, Incorporated and Interstate, Inc.) So we were not happy to run across an outfit called the Reason Foundation and its “Annual Privatization Report 2008.”
However, having plumbed about half its 120-page depth so far, a few observations and a somewhat modified stance are called for:
Aug 22, 2008
What I Can Do. What You Can Do.
Feeling powerless? Well, cut it out! Because you’re not.
Our elected representatives have to come to us, hat in hand, every two, four, or six years to renew their sinecures—excuse me—their offices. And regardless of the degree to which their obscenely expensive campaigns are underwritten by corporate interests, it’s still, thank heaven, “one voter, one vote” in this country, and our representatives are keenly aware of this.
They are also aware that the point of view made known to them by one person represents the point of view of many others from whom they are not hearing. So your letter, phone call, or email gets their attention, you may be sure. This makes it your responsibility to make that point of view known.
There are many online organizations that have automated the process of sending email communications to legislators, and have made it easy for you to sign on to those efforts. However, these emails are more like signing petitions, which is fine for its purpose. However, a personal communication from you to your legislators carries an impact beyond these group petitions, for the reasons noted above, and we should all get in the habit of making our views known in personal communications to our legislators as often as an issue arises about which we feel strongly.
Finding Your Legislators: The link below will take you to the page on Congress.org’s site where you can find all your state and federal elected officials by entering your zip code in the box in the left-hand column. Contact information, as well as information on bills your legislators introduced or co-sponsored, and their votes on important legislation can all be found here.
I gather my state and federal legislators into two email lists that make it easy to send to all of them with one message. Legislators who limit their Internet contact to forms you have to fill in on their site, as opposed to email addresses, should be encouraged to provide the latter.
Another site worthy of mention, from which you can keep a close and detailed eye on your state legislators, is the State Legislatures Internet Links page on the National Conference of State Legislatures site.
Your voice is as important as—and probably more effective than—your vote. Make it heard!
Aug 21, 2008
That’s how many computers Peru is purchasing, then distributing to the poorest of their poor children throughout the country. They’re the first, biggest, and most important testing ground for Nicholas Negroponte’s One Laptop Per Child (OLPC) program. Peru will spend about $80 million on these systems, each of which will contain a rich variety of application programs, books, games, wireless connectivity to other OLPC’s and Internet connectivity as well.
Before the Luddites remind us how it takes more than technology to improve education, be aware that the children who will receive these computers hardly even have schools. They have no books or other equipment, their teachers are not much better educated than they are, and their lives have little or no scope beyond the confines of their remote villages. The world holds its breath in anticipation of what may be wrought by this effort.
The government of Peru is to be highly commended for its vision, its generosity, and its daring. Success is by no means guaranteed, and the Luddites are right when they say that throwing technology at a problem does not solve it. But “the Internet Changes Everything,” and computers hold the potential to revolutionize the education of the masses to the same degree as did the invention of the printing press, and perhaps to an even greater degree.
So let the games begin!
Aug 20, 2008
Think tank reports are usually something of a yawn, and when they come out with the recommendation of the Brookings Institution I approach them with a large round cardboard container of Morton’s salt in my hand.
However, I just came across one touted on the Brookings site but coming from the Center for a New American Security (CNAS). Their “About Us” page shows a nicely multiracial bunch of guys in ties and gals in what I take to be pant suits (I can’t see their pants), looking very well-paid and healthy on a floral veranda outside their no doubt plush D.C. offices.
Their report, titled “Strategic Leadership: Framework for a 21st Century National Security Strategy,” is actually a joint effort among a number of entities whose identities are not made entirely clear. Affiliations among the authors include the Senate Foreign Relations Committee (staff director), the Brookings Institution (twice), CNAS, Duke University, Hoover Institution/Stanford University, Albright Capital Management, Princeton University, Center for American Progress, and the University of Texas at Austin. Something called FoxKiser apparently provided the conference room and the bagels.
A favorable review of the report in Atlantic.com1 reveals that an unnamed early participant was Susan Rice, who dropped out because she is “so closely involved with the Obama campaign.” I am glad I ran across this little morsel, because if the report is at all a reflection of the foreign policy thinking of the Obama camp, it moves me a bit further along on the Obama route to the polling booth in November. Some outtakes from the Executive Summary, with not-so-subtle subtexts emphasized:
Aug 19, 2008
Americans drove nearly 10 billion fewer miles in May 2008 than they did in May 2007.1 We still burned through a goodly pot of nonrenewable energy driving 254.7 billion miles. Let’s see, figuring a generous 20 miles to the gallon, that’s around 13 billion gallons—just in May! Our grandchildren are going to be appalled at our profligacy.
Meanwhile, what should be cause for some celebration has suddenly morphed into an accompanying catastrophe. In an article on Stateline.org, we learn that “States worry about dwindling road funds.” States use funds from gasoline taxes to pay for road, rail, and bridge work, sometimes supplementing those funds with taxes from new car sales. With both driving and new car sales down, their departments of transportation are beginning to feel—in the immortal words of Tom Lehrer—like Christian Scientists with appendicitis. The panic that has set in has reached Congress, where they are trying to grab $8 billion from the General Fund to make up a shortfall in this year’s Highway Trust Fund. Bush, of course, is opposed, as he is opposed to all measures to benefit anyone but America’s wealthiest. Key interest groups, such as the American Association of State Highway and Transportation Officials, say 400,000 jobs could be at stake should funding expected from Washington be delayed.
This “perfect storm” of bad news for the transportation sector strikes me as a golden opportunity. Higher gasoline prices have done what no amount of palaver, handwringing, and fancy think tank reports have been able to accomplish—we’re driving less, carpooling and busing more, and buying smaller, more energy-efficient vehicles. And what’s happened because of that in the last couple of weeks? The price of gas has plummeted. Hip-Hip Hooray! Now let’s keep up the momentum, and raise federal and state gasoline taxes proportionally to a sufficient level to fund our infrastructure maintenance. This will keep the price of gasoline up there around $4 a gallon; people will, at that rate, continue to drive less and make smarter new car purchases; and the price of gasoline may be stabilized—right at that threshold of pain that encourages us to do the right thing.
And out of a perfect storm of bad news comes a bright new day. Whaddaya say, Barack?
Update: We dropped even more miles in June, driving 12.2 billion miles less—a 4.7 percent decline—from June 2007.2
1Nearly 10 Billion Fewer Miles Driven in May 2008 Than May 2007, U.S. Department of Transportation (Accessed August 12, 2008)
2Fewer Americans hit the road in June, by Martin Zimmerman in the LA Times, August 14, 2008 (Accessed August 14, 2008)
Aug 18, 2008
The Office of National Drug Council Policy, a component of the Executive Office of the President, has published its latest jeremiad against the civilization-threatening evils of weed, “2008 Marijuana Sourcebook—Marijuana: The Greatest Cause of Illegal Drug Abuse,” a report so fearsome, and fear-mongering, they had to name it twice. Their numbers come from the Substance Abuse & Mental Health Services Administration of the Department of Health and Human Services, another component answerable to the executive branch, and so—these days—are advisedly taken with a grain of salt.
For instance, they say that in 2006 14.8 million Americans smoked marijuana in the month preceding their poll. That’s about 4.8 percent of the population and I can’t believe so few tokers were abroad. Perhaps that’s because I live in Vermont, the only state that shows the consistently highest usage rate (greater than 7.51 percent) across all its counties. Most of the rest of the country shows a usage rate between 4.76 percent and greater than 7.51 percent, which also casts doubt on that 14.8 million/4.8 percent number. Then, of course, there’s the problem of the undercount. I mean, if you were high, would you admit it to some buttoned-down government type with a clipboard?
Usage peaks at age 20 (20 percent), then declines rapidly to the 55-59 set (about 2 percent), takes a slight bubble-up in the 60-64 age group (where I am happily ensconced at present), then drops to a negligible number thereafter (among the oldsters who really know how to keep their mouths shut).
The graphs and figures go on (and on), but the picture isn’t much different than it was in 1936, when the movie came out (“Women Cry For It—Men Die For It”). Meanwhile anyone who’s ever smoked a joint knows it’s a puppy dog compared to alcohol addiction.
So why is marijuana so demonized by the establishment? There are a number of arguments for this. The liquor lobby is the one most often cited. They are aware of the threat posed by marijuana. Stoners are much more likely to crack open a package of chocolate chip cookies than a beer. The travel industry can’t be happy about all those heads tripping out right in their own living rooms. The truth may be less related to economics, however, and a good deal less admirable. And it is to be found in those usage numbers, showing it peaking at age 20. Marijuana is, largely, kids’ stuff, and children are not well-loved, trusted, or cherished in America. In fact, they are more often feared and loathed, and so the long legal arm of the establishment falls most fiercely on them.
Meanwhile, Canada, not a nation known for its predilection for whoopee, has been inching toward full legalization of marijuana for some time now. Ontario started the ball rolling in 2000 by overturning the statute containing a blanket prohibition of marijuana, because it did not make an exemption for medical marijuana uses.1 Since then, public use of marijuana has been increasingly tolerated (as it is in many other countries) and other legal cases have upheld that first one. A Canadian Senate committee on illegal drugs has called for its legalization.2
That is the same Canada which opted out of Bush’s mideast adventure when it failed to gain U.N. sanction. And I’ll drink to that—if I have to.
1R. v. Parker, 2000 CanLII 5762 (ON C.A.) (Accessed August 9, 2008)
2“Legalize Marijuana Now Says Canadian Senate” (Accessed August 9, 2008)
Aug 17, 2008
The Archie Bunker of the federal government, the Environmental Protection Agency, not happy with closing its libraries and cutting off vital research materials for its own scientists1—never mind the pesky public who pay their salaries— has now ordered its employees to stifle themselves and not to speak to the press, Congress, or its own inspector general.
Public Employees for Environmental Research (PEER) is a watchdog organization made up of public employees who don’t care for the sort of tactics used by agencies such as the EPA, which are putatively responsible for protecting our environment and doing so in an open and accountable manner. PEER’s recent news release, “EPA Staff Ordered to Stonewall Investigators and the Media,” relates how the EPA’s latest fiat implies a readiness to fire any employee who speaks even to their own internal investigative body or the Congressional Government Accountability Office. The move is typical of an administration which has stonewalled with impunity public and congressional attempts at factfinding, even going so far as to ignore Congressional subpoenas. The Office of the Vice President is a famously closed book to press and public alike.
Speaking of a book, you could fill one with the information resources—databases, libraries, expert testimony, public knowledge that suddenly becomes classified—that this administration has stifled. And someone should. The Federation of American Scientists has provided a good start, with a long list of Bush documents and press briefings regarding secrecy.2 And way back at the end of 2002, OMBWatch.org provided an excellent summary of the ways and means by which the Bush administration was taking us from a “right to know” to a “need to know” society.3
We’ve come a long way since 2002, to a day when public resources can be shut down at will by some faceless bureaucrat, and public employees excluded by interoffice memo from first amendment protection.
1“Critics say EPA closed libraries too soon,” by Wade-Hahn Chan, at FCW.com (Federal Computer Week web site) (Accessed August 8, 2008)
2“Bush Administration Documents on Secrecy Policy” (Accessed August 8, 2008)
3The Bush Administration’s Secrecy Policy: A Call to Action to Protect America’s Values from OMBWatch (Accessed August 8, 2008)
Aug 16, 2008
Forget what it’s going to cost us to put the brakes on global warming. Let’s look at what it’s going to cost us not to. Since October 2007, the Center for Integrative Environmental Research (CIER) at the University of Maryland has been publishing national, regional, and, now, state-level studies that assess “The U.S. Economic Impacts of Climate Change and the Costs of Inaction.” The bottom line: Climate change will affect the entire country, although unevenly among various regions; its negative aspects will outweigh the positive ones; and it’s going to cost us, through increased public budgets, higher prices, reduced income, and job losses.
The past is prologue, and the reports base many of their estimates of coming hardships on the patterns that have already begun to develop, patterns involving demonstrably and alarmingly higher temperatures, increased wildfires, droughts, flooding, and other extreme weather conditions. CIER makes two overarching recommendations: Set a national policy to immediately decrease greenhouse gas emissions coupled with a plan to adapt to unavoidable impacts; and set up regional and sector-specific studies to guide climate policy and investments, then make those investments by setting free “the intellectual power of the nation’s universities and [research] labs.”
Then hope it’s not too late.
Aug 15, 2008
Supply-side economics, often conflated with the term “trickle-down economics,” is premised upon a simple proposition: Cut taxes and the economic growth resulting from the freed-up capital will more than make up for the lost revenue. Our nation has been in thrall to this reasonable-sounding notion for thirty years, since the Reagan administration gave it a go. You will recall our national debt hit $1 trillion for the first time during Reagan’s first year in office1 and went soaring into the stratosphere from there through Bush 1, only to be tamed, finally, by a Clinton administration that left office with a budget surplus. The “Big Lie” has continued throughout the Bush 2 administration, however, and the national debt is now $9.5 trillion, increasing over $1.7 billion every day (largely thanks to the Iraq and Afghani conflicts).2
It’s time to bury the Supply-Side, Trickle-Down fantasy, and the Center on Budget and Policy Priorities does so handily in their recent report, “Evidence Shows that Tax Cuts Lose Revenue.” And there’s so much evidence that even Bushite economists are backpedalling from such absurd voodoo economics.
Reminder: Have you claimed your Economic Stimulus Payment yet? Five million Americans who aren’t required to file a tax return haven’t.3 Go to this IRS web page to find out how you can get yours.
1The Presidents, by Henry F. Graff, Simon and Schuster, 2002, p. 518.
2U.S. National Debt Clock
3“More Than 5 Million Americans Still Need to Claim Their Economic Stimulus Payments,” from the Center on Budget and Policy Priorities (CBPP)
Aug 14, 2008
Since the days of Enron and the other corporate debacles that rang in the beginning of the new millennium, a huge industry has grown up that purports to provide independent judgments on the quality of corporate governance. The industry is dominated by four firms, the best known being Institutional Shareholder Services (ISS). It was sold in 2001 for a reported $45 million.
By tweaking numbers available through SEC filings and other public sources, these companies come up with ratings that they claim can predict future performance of the companies. Problem is, they don’t. In a recent study by the Stanford Graduate School of Business entitled, “Rating the Ratings: How Good Are Commercial Governance Ratings?,” the authors conclude that they aren’t very good at all. The study looked for correlations among the ratings of four leading watchdog companies and five basic performance metrics: restatement of financial results, shareholder lawsuits, return on assets, and some things called the Q Ratio and Alpha which only someone who spends 24/7 wringing money out of the stock market can understand. They found slight to no correlation among the elements, and practically no agreement among the leading companies’ ratings (many of the same corporations were rated by more than one watchdog).
So why then did a company that sold for $45 million in 2001 manage to get itself sold again in 2006 for over half a billion dollars, despite the fact that its product is, well, worthless? I guess it just proves that, even in the heady regions of high finance, there’s one—or two—born every minute.
Aug 13, 2008
The Commonwealth Fund, “a private foundation that aims to promote a high performing health care system,” supports independent research on health care issues. They produce a biannual National Scorecard on U.S. health care, scoring our system on 37 indicators of performance that are summarized within six criteria: Healthy Lives, Quality, Access, Efficiency, Equity, and Overall Score. In 2006, our health care system scored a dismal Overall Score of 67 out of a possible 100 “when comparing national averages with benchmarks of best performance achieved internationally and within the United States.”
In 2008, we dropped two points.
Most worrisome was the nine-point drop (from 67 to 58) for access to health care, as 35 percent of adults aged 19 to 64 who were un- or underinsured in 2006 grew to 42 percent in 2008. At that rate, half our population, which pays twice what the rest of the industrialized world pays for demonstrably inferior medical care, will be without adequate access to inadequate care by the end of the decade.
“Why Not the Best?: Results from the National Scorecard on U.S. Health System Performance, 2008” asks a very good question. The answer is a simple one known to us all. We don’t have the best—or anything like the best— because in America health care is a business, and that means it is profit based, and that means it must be provided at the lowest possible expense and at the highest price it can command. And thus we get a meager product at a premium price. And until we take it out of the realm of business, it will continue to deliver less and less for more and more.
Some staggering numbers from the National Coalition of Health Care.1
Aug 12, 2008
Kiva is an organization that manages a web site for soliciting donations from “social investors” to third-world entrepreneurs, and funnels those donations to the microfinance institutions (MFIs) which disburse the funds and receive the payments back from the entrepreneurs. Kiva’s mission is “to connect people through lending for the sake of alleviating poverty.” They currently list 101 MFIs, which they call “Field Partners,” on their site.
The site is full of information regarding donors and the individuals seeking loans to start or support small, often family-run, businesses, and Kiva makes it easy for donors to find and fund entrepreneurs they wish to support. The extent of activity on the site is made clear by statistics Kiva provides. In one recent week, $631,600 was lent out; 1,479 entrepreneurs were funded; 2,766 new “lenders” joined Kiva; 8,295 “lenders” made a loan; and 555 loans were repaid. Though not as world-shattering as one might hope, this level of activity is nonetheless admirable. We have been a member of Kiva, and regular donor, since April 2007.
We use the word “donor” and put the word “lender” in quotation marks because that is one of the problems with Kiva. Those of us whom Kiva calls “lenders” aren’t, because lenders expect a return on their loan and we don’t get one. If a borrower pays back a loan which we helped with (and a remarkably high number—99.7 percent to date—do), all we get is the amount of our contribution back, which we are then encouraged to contribute to someone else. This, of course, is contrary to the point of making loans, which is to risk capital in the expectation of improving upon it. The MFIs receive the interest on the loans—the average rate, according to Kiva, is 21 percent—but the lenders do not (nor does Kiva). Furthermore, our donations are not tax-deductible. We therefore become what Kiva calls “social investors,” people who support this initiative for altruistic motives.
This fact is not made very clear on Kiva, another problem with the site. The “About Lending” section of the Help Center doesn’t mention it, and one would expect it would be there. It is found toward the bottom of the “How Kiva Works” section, where, in answer to the question, “Do I get interest on my loan?,” Kiva simply says by way of explanation, “No, loans made through Kiva’s website do not earn any interest ... Providing interest to our lenders is legally complex. However, we may provide this option in the future in accordance with U.S. law and regulations.” We hope they do, and soon. The repayment rate is high enough to make these extremely attractive investments, and we would increase ours in Kiva severalfold if we had the opportunity to earn as much as we could get on a 12-month CD.
Although Kiva claims it “will not partner with an organization that charges exorbitant interest rates,” 21 percent (as an average rate) seems high to us. It does to Mohammad Yunus as well. He is the man who made micro-lending famous (and won a Nobel Prize for it). He has been quoted as saying that MFIs should charge for the cost of borrowing funds plus 10 to 15 percent for operating expenses. His Grameen Bank charges 20 percent interest to borrowers.1 That’s problem #2.
Problem #3 is more intractable. Many borrowers on Kiva are women, and many lenders, acknowledging the dismal, often criminal, treatment of women around the world in general and in the countries Kiva serves in particular, are careful to select female entrepreneurs for their donations. Unfortunately, as we have discovered (Kiva is admirably frank about disclosing borrowers’ stories as they become known to them), the female borrowers are often no more than “fronts” for a male behind the scenes (often a husband or other family member) who actually receives the funds and uses them for purposes other than the stated ones.
Kiva has attempted to gloss over this fact. In a private correspondence in late June 2008, a Kiva Customer Service Manager made the following argument to me regarding this situation:
“It’s important to note that many microfinance institutions will not lend to men, per their mission, and, in instances where women participate in the family business, women will often act as the business manager and point of contact for loans to fund family businesses that they receive through their local MFI. In this capacity they are the ones who complete the loan applications, have the funds disbursed to them, make scheduled repayments, and otherwise administer the loan. Far from a position of indignity, this gives the women in the family significant power over the family business and a level of participation that some may not ordinarily have. It also helps them to establish relationships with their MFI so that, if they so choose, down the road they can take out a loan to start their own independent business.”We will quote our response to this in some detail, followed by my conclusions:
I ... discover from your response to my query that such arrangements are common—the woman applies for the loan and is the figurehead recipient, but the funds go directly to the husband. And this is because many MFI[s] will not lend to men! Logic worthy of Lewis Carroll, and a cynical Lewis Carroll at that. And, of course, the people you are relying upon to provide the capital for these loans are not informed of this arrangement.HOWEVER, let me conclude with the following:
I want to reiterate a point I made, and a point which I believe many of your [field] partners—who loan only to women—are trying to make: This world is ruled—badly—by men. Women are routinely exploited, oppressed, beaten, raped, and killed by men, and with impunity. Microfinance provides a way out for these women, a means to procure some independence, self-esteem, and empowerment. Many of us believe that liberating and empowering the world’s women provides one possible means of saving a world which is otherwise lost. If our support of these women is to be undermined by deceptive advertising, whether initiated by Kiva or your [field] partners, then we may need to take our money, our hopes, and our ideals elsewhere.
A rather extreme position, you will probably say. And no doubt there are many instances where the woman plays the part you describe in your note and does, indeed, win a measure of respect, value, and independence in playing that part. I suspect there are many more instances, however, where she is simply being used by the males in her family and, in these instances, so are we and, I would think, so is Kiva.
I admire the operation you have put together, and the beauty, comprehensiveness, and utility of your web site. I even admire the frankness which is evident in much of the informational material on the site. However, the problem at issue is not a trivial one, and I am sincerely sorry to say your response has not adequately addressed it.
Aug 11, 2008
We’ve previously noted the ill effects that can arise from letting the private sector intrude on the public infrastructure that delivers and treats our water (see Water, Incorporated). Now comes this Congressional Research Service (CRS) report (RL34567) on “Public-Private Partnerships in Highway and Transit Infrastructure Provision.”
We are moving into Phase II of all those tax cuts we’ve been seeing over the course of the last several administrations. We see now it was all for the purpose of starving government to the point it had to consider introducing the profit motive into areas where the profit motive is inappropriate. Business is a wonderful thing in its place. In a free market where competition is assured, where transactions may occur—or not—between a willing buyer and a willing seller, businesses must be lean and quick, grabbing at opportunities that present themselves and dropping hot potatoes with dispatch. The rough-and-tumble of markets, of buying and selling, of profit and loss, of growth and decline, have no place in the public sector, where products and services essential to a stable social infrastructure must be delivered equally to all, without regard to considerations of supply and demand.
The private sector has one responsibility to its constituents, who are its owner/shareholders and not the public, and that is the maximization of profit before and beyond any other consideration. And that is as it should be. And that is why the private sector must be kept out of the public sector. And that is why only a single-payer, public health care system will ever work—perhaps not as well as we might want it to in our ideal imagination—but far better than it ever could if kept within the private sector, and far, far better than it does now.
And that goes for our roads, our tunnels, our bridges, and our entire transportation infrastructure. Where we have privatized it—in the railroads, in the airways, and in the airwaves—it’s a mess, with no consideration but that of delivering a minimal product at a maximum profit.
Aug 10, 2008
What are the consequences of arrogantly bullying one’s way into a unilateral, pre-emptive, unjustified, and hopeless conflict, then stubbornly pursuing it for six years against the wishes of the international community and even of one’s own citizens?
Among the serious consequences is the sorry fact that the U.S. finds itself becoming the Rodney Dangerfield of international relations. With our enormous military might stalemated year after year by disorganized gangs of ill-equipped street thugs, our credibility, our integrity, and our influence have steadily dissipated, not to the least degree among the very countries most affected by our present misadventure.
In a report entitled “The New Arab Diplomacy: Not With the U.S. and Not Against the U.S.,” by Marina Ottaway and Mohammed Herzallah, the Carnegie Endowment for International Peace draws the following dispiriting conclusions:
In general, a growing web of diplomatic initiatives and contacts is being spun throughout the Gulf and the Levant, and the United States is not part of it ... The hard-line, confrontational policy the United States has embraced under the Bush administration has inadvertently demonstrated the limits of U.S. power ... The rejection of diplomacy has thus reduced the United States to a condition of self-inflicted powerlessness regarding many problems. The vacuum is being filled in part by U.S. adversaries—Iran, Syria, HAMAS, and Hizbollah—and in part by friendly Arab regimes, which seek to find a way forward in situations where U.S. policy has contributed to stalemate ... In this new regional diplomacy, Saudi Arabia has emerged as a major player while Egypt has sidelined itself in the waning years of the Mubarak regime, turning inward while it waits for the succession—and possibly a succession crisis—to unfold ... [M]ost Gulf countries and even Egypt no longer believe the Bush administration can contribute to solutions because of its unwillingness to talk to and negotiate with all sides and to help forge compromises ... the United States now has little leverage over the policies of even friendly countries....A sorry legacy for the next administration to confront.
Aug 09, 2008
That’s six trillion, 393 billion, 94 million dollars. And that’s how much we've spent—in 2008 dollars—on all the wars we’ve fought since the American Revolution. Which, at only $1.8 billion, was a bargain.
In a bit over five years, we have spent almost as much—$648 billion—fighting a losing conflict in Iraq as we spent fighting the losing conflict in Vietnam over ten years ($689 billion). We’ve spent in Iraq more than 10 times the amount spent in the Civil War—by both sides combined.
Furthermore, these estimates do not include costs of veterans’ benefits, interest paid for borrowing money to finance the conflict (and almost all the money for Iraq has been borrowed. Our nation’s grandchildren will pay for it in a starkly lower standard of living), or assistance to allies. Indeed, it has been estimated by credible economists that the Iraq boondoggle has already committed us to total spending in excess of three trillion dollars.1
All this comes from a Congressional Research Service (CRS) report (RS22926) released late last month.
Read it and weep.
1The Three Trillion Dollar War, by Joseph E. Stiglitz and Linda J. Bilmes, W.W. Norton, 2008 (Accessed August 2, 2008)
Aug 08, 2008
I don’t support our troops.
I don’t write them letters or read their blogs. I don’t mourn them when they die or are disabled. I don’t grieve with their parents, who grew up during the Vietnam war and, in many cases, participated in it, and should know better—a lot better.
No, I don’t oppose the war while supporting the troops because the troops are supporting the war voluntarily, mindlessly, recklessly, by putting their lives at the service of a lying, grasping, illegal administration that should have been impeached as soon as it was clear that they knew all along that the justifications they put forth for invading Iraq were bogus.1
Our troops, for all their sacrifices (and 4,127 of them are dead and 30,324 are wounded as of today2), are willing pawns in another militaristic and imperialistic blunder by the world’s great bully. This administration has bankrupted us financially,3 and it has bankrupted us morally.4 They have torn up the greatest document the world has ever known establishing self-government by a free people. They have destroyed the symbol of our nation as a beacon to the world's oppressed who struggle in darkness toward freedom. In the memorable imagery of Robert Bly, “They are loosening the nails on Noah’s Ark.”
And we, the people, have let them do it, and our troops have been at the forefront of the enablers, without whom the bullyboy neocons could not have gotten us and our world into this unholy mess.
“What if somebody gave a war, and nobody came?”5 Maybe next time.
1“Waggy Dog Stories,” by Paul Krugman, New York Times, May 30, 2003 (Accessed August 2, 2008)
2Iraq Coalition Casualty Count, on icasualty.org (Accessed August 2, 2008)
3“Scary deficit forecast calls for straight talk,” Des Moine Register, August 2, 2008 (Accesed August 2, 2008)
4“America Is Bankrupt,” by Ronald van Raak, SP International, August 1, 2008 (Accessed August 2, 2008)
5Allen Ginsburg on Quoteland.com (Accessed August 2, 2008)
Aug 07, 2008
Nothing says “All Together Now” like workers banding together to collectively bargain for better working conditions. The U.S. has over a hundred years’ proud history of workers struggling to win unionized representation. Still, the percentage of unionized workers in the private sector has plummeted from over 16 percent in 1983 to under eight percent today. The fact that wealth has become increasingly—obscenely— concentrated in the hands of the few over that same quarter century is no coincidence.
The nation’s largest private employer, Wal-Mart, whose family ownership contains some of the richest people in the world, has worked hard to keep unions out. With a Democratic victory threatened in November, Wal-Mart is particularly frightened of the Employee Free Choice Act (House version is H.R. 800,; Senate version is S. 1041). This bill, which has passed in the House and is now under consideration in the Senate, restores some of the balance of power to workers in their struggle to form unions. That balance has been heavily shifted to management during the past several administrations. Wal-Mart has recently begun ramping up their opposition to this bill, with a campaign to intimidate their workers.
Wal-Mart Watch, an organization “working to make Wal-Mart a better employer, neighbor, and corporate citizen,” is trumpeting a recent page one article in the online Wall Street Journal, about Wal-Mart’s activities, and organizing a petition to tell Wal-Mart to stop intimidating its workers. You can read the WSJ article and sign the petition at the URL below.
Aug 06, 2008
In an admirable example of “All Together Now,” 24 laboratories across the province of Ontario will band together to seek out the next generation of cancer-fighting therapies and deliver them quickly to patients.
“The problem (of cancer) is vast,” said Dr. Robert Rottapel, the program’s director. “If we work together, our efforts will certainly have a bigger punch. We’ll get there faster.” From the article:
The researchers plan to screen the entire cancer genome to identify specific genes, proteins or genetic networks that are important for tumour growth or carcinogenesis, the process by which normal cells turn into cancer cells. They will then develop drugs that target these specific molecular and cellular changes and will therefore only destroy the cancer while protecting the surrounding normal tissue.
Aug 05, 2008
One-third of American families with children are classified as low income because they earn less than twice the federal poverty level. As they add hours and/or family members to the work force, they quickly cease to qualify for various modes of assistance available to them, rendering the additional income far less valuable than that obtained by their initial efforts.
A pair of new reports from the “nonpartisan” Urban Institute entitled, “Making Work Pay Enough,” and “A New Safety Net for Low-Income Families” propose a number of policy tweaks that federal and state governments can make to those assistance programs to remove the disincentives to self-improvement for these families. (The first report is available at the link below; the second is available here.)
Meanwhile, the second of three increases in the minimum wage—arguably the only accomplishment of the 110th Congress, and a shamefully meager and mean-spirited one at that—kicked in last month. The first increase, in 2007, took the wage from $5.15 an hour to $5.85; last month’s to $6.55, and next year’s final increase will send it soaring to $7.25. As has been the case since 1997, one full-time worker in a minimum-wage family will continue to make about half the federal poverty level.1
I take the biblical adage, “The workman is worthy of his hire” to mean that if you are going to take advantage of someone’s full-time labor, you owe them a living wage. All the policy tweaks in the world won’t bring about the justice this situation calls for. The American worker and the American people need to wake up. CEO’s are making more than 500 times what their average worker is making,2 and the middle class has seen a net loss in income during the present administration.3
This government was founded on principles of equity, in opposition to the accumulation of wealth in a few hands. The first step to restoring our nation’s economic health should be to raise the minimum wage to a living wage (which will vary from state to state), and keep it there by indexing it to a real annual cost-of-living increase, and not to the cruel fiction of the Consumer Price Index.4
1Oregon State University (Accessed July 30, 2008)
2Wages in America: The Rich Get Richer and the Rest Get Less, from The War at Home: The Corporate Offensive in America From Reagan to Bush, by Jack Rasmus (Accessed July 30, 2008)
32005 Incomes, on Average, Still Below 2000 Peak, David Cay Johnston, citing IRS data, in the New York Times, August 21, 2008 (Accessed July 30, 2008)
4“Using the Consumer Price Index to Rob Americans Blind,” by Richard Benson, at SafeHaven.com (Access July 30, 2008)
Aug 04, 2008
Sometimes, however, numbers tell a pretty surprising story.
I want Ralph Nader on the ballot, not because I want him to win, which he can’t barring a sudden return to consciousness of the stupefied electorate, but because I want his voice in the debates. As the only one among the three frontrunners who has even mentioned the international corporate hegemony which is destroying our world, the only one who supports a rational universal medical health plan, the only one who has pledged to get us out of Iraq, the only one who has promised to reduce a military budget that is almost as large as the rest of the world’s combined,1 the only one supporting impeachment, the only one in favor of a direct vote of the people on matters of critical national importance, as the only one among Obama, McCain, and himself who is advocating these positions, I want him heard on a national forum—and I want to hear what the other two have to say in opposition to these sensible and necessary positions.
So I have been working on gathering signatures to help get Nader on the ballot in Vermont, although fairly sluggishly. As I’ve opined elsewhere on All Together Now, it has been my belief that Nader has a better chance of playing spoiler for Obama’s chances this year than he had in 2000, when Gore—for all the howling recriminations voiced by my fellow progressives—clearly lost the election for himself.
But lo and behold! A recent NBC News/Wall Street Journal poll (taken July 18-21) shows Obama ahead of McCain 47-41 in a two-way race. Obama’s 6-point lead, however, is doubled when both Ralph Nader and the Libertarian candidate, Bob Barr, are included in the race. Then it’s Obama 48 to McCain’s 35. McCain’s hold on his cool, skittish, fed-up constituency is so weak that if you throw a Nader and a libertarian into the mix, they steal votes from him.
So I’m back on the streets this weekend. Nader needs 1,000 signatures to get on the ballot in Vermont. He has signatures enough for 18 state ballots already. If you’d like some fireworks in the debates, say you’re for Nader when the pollsters call. Apparently, it can only hurt McCain.
[Update: Nader has gathered the 1000 signatures needed for Vermont.]
1Global Issues (Accessed August 4, 2008)
Aug 03, 2008
The Brookings Institute has provided useful summaries to Obama and McCain’s positions on seven critical topics facing our next president: fiscal responsibility, children, Iraq, health care, immigration, climate change, and trade. I wish they had included positions held by, at least, Ralph Nader and the Green Party, both of which share important positions on ending an endless war and relying less on old energy technologies with proven and intractable drawbacks. Knowing Brookings, it is also understandable that they have altogether missed the most pressing issue of our day, and one which affects, and to a large degree determines, the efficacy of efforts to ameliorate the problems associated with the seven topics they do cover: international corporate hegemony.
That quibble aside, the summaries clearly show that McCain is cleaving to the positions of an administration which has threatened our nation to a far greater degree than any cave-dwelling terrorist ever could, has squandered our treasury in a failed attempt to combat international terrorism, torn up the Constitution, diminished us to Lilliputian proportions throughout the world and in our own eyes, and filled its own and its cronies’ pockets to the detriment of its citizens’ fiscal health to a degree unheard of since the worst excesses of the heyday of European aristocracy.
Obama’s single greatest challenge, should he manage to get elected, will be to confront that corporate hegemony and the devastating consequences it has wrought upon the world, and restore government of the people, by the people, and for the people. And nothing in the Brookings summaries or anywhere else I have found indicate to me that such an effort is on his agenda. It is Priority One on Nader’s, however. And until it at least appears somewhere on Obama’s to-do list, I cannot vote for him.
Aug 02, 2008
The Nation has a heartfelt “Open Letter to Barack Obama” asking him to “listen to the voices of the people who can lift you to the presidency and beyond” (I’m not sure where the “beyond” they refer to might be, but never mind). They want Obama to return to his primary campaign roots and espouse the positions and ideals he voiced so eloquently then and which he seems now to be backing away from.
Most distressing to many was his reversal on the FISA re-authorization bill that included retroactive immunity for the telecomms that may have conspired with the executive branch to spy on Americans. From a position promising to filibuster any bill that included that provision, Obama ended up voting in favor of it.
Of course, a politician’s first duty is to get elected. However, if Obama continues to abandon the people who brought him to the threshold of the Democratic candidacy, he is going to lose many of them in November—to Ralph Nader, to Cynthia McKinney, to Bob Barr, or to stay-at-home apathy. And that could cost him the race, and cost this nation a chance for a fresh start.
Aug 01, 2008
Here are a few items noted with interest over the past month:
Copyright © 2008 All Together Now.