Thursday, March 22, 2012

Paul Starr’s Remedy and Reaction offers insightful review of the history of U.S. health care reform

By Marc Jampole

With the Supreme Court considering multiple challenges to the constitutionality of the Affordable Care Act of 2010 next week, Progressive Populist readers might want to delve into the long-term history of health care reform in the United States. If so, there is no better place to go than Paul Starr’s recent Remedy and Reaction: The Peculiar Struggle over Health Care Reform, which traces health care reform from the earliest proposals for government-sponsored health insurance just before and during World War I.

Starr is without a doubt the guy to tackle the subject. Since its 1984 publication, his Social Transformation of American Medicine has become established not just as the seminal work in the narrow field of health care, but as one of the very most important books of American social history. Since then, Starr has taught, conducted historical research into both health care and the media and served as a senior health care advisor for Bill Clinton. He is co-editor of The American Prospect.

Here are some of the insights that I gleaned from reading Remedy and Reaction:

A lost golden moment
There was a golden moment when all the stars were aligned for a major overall of the healthcare system which would have ensured that virtually every American had healthcare insurance. Both Republicans and Democrats pretty much agreed on what to do, the various constituencies such as insurers, physicians and the public were either on board or not opposed and the president in charge supported the idea and knew how to get things done. Unfortunately, the president was Richard Nixon and a potentially watershed moment drowned in the Watergate scandal.

Mitt Romney's important role
Starr documents that the Affordable Care Act is profoundly the child of the successful Massachusetts plan that Governor Mitt Romney competently shepherded to passage and then efficiently implemented. The federal plan is derived from the same philosophy and using pretty much the same set of strategies and tactics as the Massachusetts plan. Starr also points out that Romney did not talk about healthcare reform during his gubernatorial campaign, but once in office he rolled up his sleeves and displayed enormous competence. Starr doesn’t say it, but I will: the Romney disavowal of his landmark accomplishment strongly suggests that Mitt is a value-free technocrat whose idea of being in charge is to implement competently the desires of his backers, whatever that means. By repudiating his own good works, Romney transforms himself from a major statesman to the ethical equivalent of an Albert Speer, that wonderfully brilliant architect and thinker who dedicated himself to accomplishing the will of his backers.

Not a socialist plot
Starr shows that the basic philosophy behind Obama’s plan from the beginning has been to cover more people and cut the cost of coverage while taking a pragmatic approach that does not profoundly upset the current complicated system that mixes public and private solutions and funding sources. Its dependence on private insurance and patient cost sharing derive from Republican ideas. So is the idea of not creating a “public option,” but instead establishing insurance exchanges, which are marketplaces for insurance for those not covered by government programs or their employers.

Like all compromises, there is something for everyone to hate and love about the Affordable Care Act. But Starr, who would probably have preferred a more European style system, brings up a stunning fact that should win the day with many centrists and progressives: The impact over Obama’s healthcare reform over 10 years will be to increase total healthcare costs in the United States by a worst-case 1 percent, while providing coverage to 32 million more people, or a little over 10% of the American population. By that math, the cost per person for health care goes down, which means that by applying some quick fixes to the current system, we cover many more people and at a lower cost.

It’s an imperfect law that doesn’t address all the challenges of perfecting an imperfect system, but it is nevertheless landmark legislation. Let’s hope the most right-wing Supreme Court since the Dred Scott days agrees.

Tuesday, March 20, 2012

For Mitt Romney, freedom’s just another word for nothing left to win

The core of Romney’s big speech in Chicago yesterday was his accusation that the Obama Administration has pursued “an assault on freedom” with new business regulations and higher taxes. The expression freedom is bandied about a lot, especially by Republicans bewailing its imminent loss—economic freedom, personal freedom, religious freedom. But what about freedom from breathing dirty air? The freedom from hunger? The freedom from economic insecurity? The freedom from disease?

We can pose both sides of most issues as a test of freedom. In the days of the civil rights movement, it was the freedom to sit in a restaurant versus the freedom to deny service in a business establishment. The current flap about contraception pits the freedom of women versus the freedom of a religion to discriminate against women.

Of course, the more we apply the word “freedom,” the more it loses all meaning. And that’s the point!

The value of any word to a propagandist or ideologue increases as the meaning of the word becomes more amorphous, harder to pin down. And there is no more amorphous word than freedom.

The first definition of freedom in Merriam-Webster’s is “the quality or state of being free: the quality or state of not being coerced or constrained by fate, necessity, or circumstances in one’s choices or actions.” The entry, however, goes on for many paragraphs and gives many different meanings to the word. The synonyms for freedom, some contradictory, suggest how easy it is for propagandists to find a meaning to fit the moment: “self-determination,” “independence,” “liberty,” “facility,” “ease”,” right,” “privilege,” “franchise,” and even “generosity” (which is not the essence of the freedom from taxation that Romney would like America’s wealthiest to continue enjoying). Then there’s Kris Kristofferson’s definition, made famous by Janis Joplin: another word for nothing left to lose.

One anecdote on the use of freedom outside the political realm should illuminate the power of words that lose meaning. A few years ago at a family Bat Mitzvah in California, the rabbi performing the service said in his sermon that “Torah is freedom. The more Torah, the more freedom.”

It was of course, a completely false statement. The Torah, which comprises the first five books of the Jewish Bible, does include many well-loved biblical stories and all of the ones told by Jews, Christians and Moslems alike. But the Torah is primarily a book of laws, 613 to be precise, whose purpose is to restrain the behavior of people, i.e., take away their freedom. Thou shall not kill. Thou shalt not steal. Thou shalt not commit adultery. These are the birds you should regard as unclean. According to the Jewish tradition, the Torah is the source for every Jewish law, even those not mentioned in it. That includes all the laws that take away freedoms related to eating, traveling and mixing the sexes in social situations.

These laws take freedom away from people. The more Torah, the less freedom. And yet so many of the congregants smiled in agreement when the rabbi equated a book of mostly proscriptive laws with freedom.

Whether he knew it or not, the rabbi was using yet another definition of freedom. Freedom is also that feeling of supreme exhilaration and limitless power that people describe as “feeling free.” I remember when I was much younger and religious, I would sometimes read the Torah and get a sudden feeling of being free, like the feeling when I used to take my feet off the pedals and glide my bicycle down a steep hill, or the feeling when I quit one job for another one that paid 36% more. Many TV commercials will say their products help attain this “feeling of freedom.”

From kindergarten on, we are indoctrinated to the importance of freedom and “the feeling of freedom” at school and in the mass media. We are taught that the United States was founded to promote freedom (at the time, of course, only for white adult males who owned property) and that the United States is a beacon of freedom to the world. One of the major themes in our history is the gradual spread of freedom through increased freedom for our citizens and in the foreign lands that the myth says we have saved. We claim that every war we fight is to protect our freedom or the freedom of the people whose land we are invading, or both. Thinking about American freedom can swell the chests of many of us with an almost swooning pride. We have learned to feel the “freedom feeling” whenever we consider our history, culture and laws.

It is this definition of freedom—this feeling—to which Romney appeals when he talks about economic freedom. When he says the policies of his party will increase freedom, he wants people’s hearts to swell with the feeling of freedom and then recoil with the fear at the thought of lost freedom because of environmental regulation, healthcare reform or raising taxes on the wealthy. He never mentions that his tax freedom results in less money for society to help people be free from disease, from ignorance, from hunger, from the helplessness of old age and from the frustration of poverty. He never mentions that his freedom from regulation makes people less free from business scams, unsafe products, dirty air and infectious water.

Many philosophers believe that the essence of civilization is restraint. Learning restraint—limiting your freedom for your future good, the good of others or the common good—is at the heart of the process of growing up from infancy into a mature member of society.

Romney and the rest of the Republicans don’t really want absolute freedom in the economic realm. They just believe that our laws should protect the rights of individuals and organizations to do as they please (outside the sexual realm) as opposed to protecting the rights of people to have the basic human dignities of food, health care, education and the opportunity to make a living and improve their lot. Those who say that unfettered economic freedom enables more people to enjoy all the other freedoms are merely expressing their beliefs, which they constantly and inaccurately present as a fact-based theory. History, however, is filled of examples of how taking away an economic freedom—the freedom to hire children, the freedom to dump toxic chemicals into rivers, the freedom to charge what you like because you have a monopoly, the freedom to pay someone less than minimum wage or the freedom to prevent union organizing—has improved society and helped the economy. It’s one set of rights versus another. We can also call them freedoms, but once we do, the concept of freedom loses its meaning.

In the realm of political campaigning, “freedom” has become something one accuses the opponent of not loving/having/protecting/cherishing. With name-calling, we say, “you’re this,” but freedom in the Republican’s sense is conjured only in its absence as a characteristic. Saying the opponent or the idea is against freedom is a highly sophisticated form of name-calling, dependent not just on conflating different concepts of freedom, but also on a body of unproved assertions and an almost autonomic emotional reaction.

But emotions aside, keep it in mind that when Romney says the election is about freedom, he means the freedom of the economic and social class he represents to continue pulling more and more wealth from everyone else through continued low taxes for themselves and low wages and declining government benefits for everyone else.

Monday, March 19, 2012

Selections from the April 1, 2012 issue

COVER/Steve Kornacki
Rush poisons GOP brand

Civil liberties on the frontier


RURAL ROUTES/Margot McMillen
Climate change strikes home

Current TV adds talkers to morning lineup;
Rush ads suspended;
Super PACs dominate;
Limbaugh's not the only one;
Super PACs dominate, are hated;
Kaptur emerges from showdown with Kucinich;
Work hours point to continued job growth;
Mitt ‘clear favorite’ of lobbyists;
Mitt declines Medicare, embraces vouchers for seniors;
Stuck paying medical bills of woman who sued Obamacare;
Another con talking point falls apart;
Medicare growth slowing;
Feds deny Texas women's health money;
Senate rejects Keystone XL pipeline order;
GOP blocks judge nominees in a snit ...

Obama weighs ins and outs of ‘insourcing’

Meaner — and dumber — than rats

GOP ‘zombies’ follow ALEC’s script

HEALTH CARE/Joan Retsinas
Bone marrow transplant and the market

Republicans practice old-time religion

Obamacare meets reality

Arab Spring avoids corporate rule

Colleges run debt peonage business

Evangelicals, Catholics strange bedfellows

French were right about Jerry Lewis

Coma ruins Neeson’s week

and more from The Progressive Populist

According to Mickey D’s,the hot spot for octogenarians to hook up for romance is Mickey D’s

By Marc Jampole

For the first time ever, the fast food version of Siva the Destroyer, AKA McDonald’s, is going after senior citizens—and I don’t mean newly AARPed 50-year-olds, but those in their late 70s and early 80s.

I saw this commercial for the first time during one of the many breaks during the last two minutes of an NCAA tournament game this past weekend.

The commercial unfolds as a series of vignettes, with quick fade-outs and fade-ins to tell us that it’s another day of the week. In each vignette, the same two elderly gentlemen—one bald--stare at what a former employee of mine once called a “senior babe,” an extremely attractive woman in her late 60s or early 70s. They make juvenile comments about how the bald one wants to go over and try to meet her. As far as attracting the attention of unknown members of the opposite sex goes, these guys don’t seem as if they’re out of practice, but rather as if they never really were in practice.

In every vignette, the would-be lover, his intended and the friend are drinking coffee or a special McDonald’s coffee drink—you know, sweetened coffee topped with a pyramid of white whipped froth consisting of corn syrup and dairy products, topped by a few rivulets of a thicker, less airy corn syrup tinted with food coloring and a roux of natural and artificial flavorings. They’re called McCafé drinks.

In the last vignette the potential suitor arrives at the table wearing an awful fitting toupee which transforms him into a pathetic clown. Meanwhile a bearded man, looking slightly younger and spryer than the toupéed jester, approaches the senior babe. Brandishing his McCafé drink as a peacock shows his tail, he asks if he can sit at her table. Her eyes light up and they begin an animated conversation. We cut back to the two oldest adolescent males in the jungle. The friend says the would-be lothario should have put the wig on his chin instead of his head. Before the McDonald’s music and logo, the scorned lover mugs pathetically with the toupee in a way that made me feel embarrassed for and angry at the guy at the same time.

What do we learn from this commercial?

We learn that senior centers, libraries, venues for volunteer activities, dances, houses of worship and family gatherings are not the best places to meet women when you are of a certain age. Instead, you have to hang at Mickey D’s on a regular basis. Of course, that’s a completely false impression. True enough, there must be groups of seniors who use McDonald’s to meet and schmooze once a week, or maybe every day. But what happens in this commercial is slightly different. It’s hanging at Mickey D’s to hook up. And what I’m saying is that the scene rings more false than cute because there are so many better places for seniors to meet and match nowadays.

We also learn in this commercial that the relationship marketplace for straight men in their 70s and 80s is pretty grim. In a turnaround of Jan and Dean’s “Surf City” (to which these characters would have probably danced decades ago), it’s three boys for every girl. Of course, that’s false, too. Death and illness give men the numbers advantage when it comes to late-in-life love. The older the age group, the more eligible women there are per eligible man. Neither Target nor Wal-Mart would ever commit such a demographic sin in one of their commercials. When they depict a demographic group in an ad, everything is right in every detail.

Target and Wal-Mart would also never make mean fun of its customers, although they both will “make fun with” their customers, as McDonald’s has also done through the years. “Making fun with” includes such scenes as the wife letting the husband think he’s making the buying decision; the couple arguing about what to do with the savings they have from buying something; the kids trying to use smart phone technology to trick dad into buying more treats. These are gentle teases which affirm the attractiveness of the target audiences. But depicting an octogenarian as an infantilized Pagliacci is inherently insulting to the characters and by implication to the demographic they represent, which is why the scene seems more uncomfortable than cute,
despite the peppy McDonald’s “ba-da-da-da-da” playing brightly in the background.

The irony is that whoever worked on this spot started with the right ideas. McDonald’s strategy to go after senior citizens is a good one, since the original denizens of Big Macs are baby boomers now retiring and aging.

To connect the consumption of a product with an emotion is a staple strategy of advertising, one that McDonald’s has pursued with a vengeance for decades, especially in spots featuring African-Americans and young adults. And as we have seen in many McDonald’s spots through the years, what better emotion can there be than romantic attraction? Moreover, one unifying theme shared by all McDonald’s spots for specialty coffee drinks over the past few years is an attitude best described as hip cuteness, and what could be cuter and hipper at the same time than seniors in love?

On paper, the spot has it all: It connects a product to an emotion, focuses on a target market that is of growing importance, and has thematic and design similarities with other McDonald’s spots that will help enhance the overall brand message that the company tries to make in all of its advertising.

Somewhere along the way, though, these strategies led to the uncomfortable and unrealistic mess we see in the commercial. Because it presents a reality that doesn’t exist and one in which the representative of the target market is humiliated, I’m certain that the commercial will fail with that target market.

But I’m betting it plays well with the enormous youth market for coffee drinks, i.e., the young and slightly unsophisticated who will accept the McCafé drink as a cheaper substitute for a beverage from a real coffee house or that corporate imitation known as Starbucks. The humor is a highly sanitized version of the crude and somewhat humiliating humor of a lot of youth movies. Young men and women can relate to the awkward dilemma of a boy wanting to pick up a girl in a fast food restaurant but being afraid to ask.

And there can be no doubt about it. That’s not Viagra or water from the mythic fountain of youth that the bearded elderly gentleman has in his hand that makes him so attractive to the senior babe. It’s a McCafé! The elixir of love.