On the value of a single payer healthcare program, again

An opinion published by Bloomberg News and reproduced in the Gazette Times ( April 11, 2024) suggested that, as a way to control healthcare costs and broaden access to affordable choices, lawmakers should reconsider introducing a public option – a government-run plan that would compete alongside private insurance companies. It cited efforts from states like Colorado and Washington that used legislative tools like premium-reduction targets, or price negotiations for reimbursement rates for hospitals and clinical providers, and concluded that it is “perhaps the most promising way” to solve our current healthcare problems.

 While early results from Washington showed the public option plans can have a moderate positive impact on healthcare costs, the experiment is in its infancy and challenges remain: many individuals reported confusion navigating the different networks and narrower choices of providers, and after 2 years, the voluntary participation in the public option is still low (11%). 

 In Colorado, which started its reform in 2019, only 15% of option plans met the premium reduction target by 2023. These findings are reported in a health forum published in the Journal of the American Medical Association (March 28) and offer cautionary tales about the overall effectiveness of public option plans in changing the current chaotic and fragmented system.

 Healthcare reform is complicated and politically challenging because it requires trade-offs that may be unacceptable to specific interest groups: private insurance corporations mostly driven by profit; providers concerned about reimbursements; patients are now consumers in a less than transparent market. The practice of medicine seems no longer an art or a science, but is now defined as a business, especially predatory now that equity firms are stepping in to buy out financially failing clinical practices. 

In this Land of the Free, we pride ourselves that Americans are able to “make choices” in healthcare, just like we would shop for goodies at a supermarket. The reality: choices, very limited; confusion, widely spread. Introducing a public option plan to “compete” with other health insurance plans may sound good, but it may not have a fighting chance: there is no guarantee that our politicians will continue to support it when the private health industry are the top lobbying spenders, and when its competitors can cherry-pick healthier members and put obstacles to medical services to minimize their own costs. 

Simply put, I’d much rather go with a single payer system: everybody is covered, with basic essential benefits, and with equal dignity. If the term “single payer” puzzles you, think of Medicare benefits funded by fair taxes and offered not just to seniors, but to everyone. If you hear that Medicare will go bankrupt in an x number of years, don’t panic. Any program, public or private, is always a work in progress, and we can adjust revenues and expenses, benefits and resources to make the program stay cost-effective and sustainable. Most of all, a Medicare-for-All will be simpler and less expensive to deliver than current health insurance plans that spend up to 15% of their revenues on administrative and advertising costs. It will also be more equitable – not a Cadillac treat for the rich and powerful, but leaving no one behind without preventive or essential medical services either. Some may call this “Socialist Medicine”, but with the majority of Americans believing that providing healthcare coverage for all is a government responsibility (according to a 2020 Pew Research Center survey) I call it democracy at its core. Although implementing a single payer program faces many challenges, let’s keep our eyes on the prize, for we cannot achieve the American pursuit of happiness without good and equitable health services for all.

  (Published in the Gazette Times, Corvallis, on April 25, 2024)

On immigration

Recently, immigration has dominated the news headlines, and I suspect it will be a divisive issue throughout this presidential season. TV screens and newspapers flash repeated images of thousands of migrants crossing rivers, walking along tall steel walls and barbed-wired fences at our Southern border - seemingly more to evoke fear of chaos among their viewers and readers than to offer concrete solutions. Voices supporting immigrants for humanitarian reasons and for their potential societal contributions are being drowned by sound bites that demonize them as criminals and blood poisons. The reality is that immigrants will melt into all the social layers and assimilate, for better or for worse, the values and predicaments that are already present in our society. Some barely surviving on welfare, many working hard at low paying jobs, and some eventually attending elite universities and climbing corporate ladders.

President JFK, Jr. reminded us that “we are a country of immigrants”, a mosaic quilt that binds us together in beautiful colors and with strong stitches. It has been so since the birth of our nation, and will continue to be so. Global migration is as old as our human species. 

 I am not suggesting that we should have open borders to illegal immigration. Yes, we need a more orderly system than what we have now. But we should not let the discussion be driven by politicians who appeal to our tribal instincts, dividing us by skin colors and calling cultural diversity a threat to our national security.

                                                                    (Published in the Gazette Times, Corvallis, March 9, 2024)

The Three Kings, then and now

Christmas is over. The Three Kings statues, packed away in their boxes, have returned to the family attic.  But hold on — there reappear on the world stage two other characters, and one trying to jump back on. 

Putin: A master fabricator of myths and lies, hiding behind an enigmatic face. He started a war that now has taken hundreds of thousands of lives, displaced millions of peaceful  people, and saturated a once-fertile land with thousands of bombshells and missile fragments that could take decades to clear once peace returns. 

Xi Jinping: Underneath his debonair smile and calm disposition, the dark side of paranoia lurks. He is out to re-impose the global role of China to its imperial glory of past centuries, first with economic incentives, now by building up and flexing its military muscle. 

And on our backstage at home, who else but our own Donald Trump: a businessman being investigated for many shady deals; a TV reality showman, part charismatic jester (“bouffon”), part bully-playing-victim, and part demagogue who delights himself and his fans with name-calling and shooting simple answers to complex problems. 

These three deeply paranoid, insecure, self-proclaimed kings long to hold the world in their hands, and spin it along their triangular axis; they command their own packs of oligarchs and populist supporters, and can start a regional or global war when they feel like it; three un- scrupulous “strong men” with fragile egos and itchy trigger fingers. 

Scary, unless we all unify to resist them. 

(Published in the GT Feb 6, 2024)

On drug patent monopoly

When the Wall Street Journal (WSJ) accused the Biden administration’s latest effort to rein in drug costs by “seizing patents” and “stealing intellectual property”, it advanced its pro-business agenda by telling us only a half-truth. 

 True: under the 1980 Bayh-Dole act, research institutions receiving federal funds are allowed to patent inventions and license them to companies to commercialize them. Missing half, also true: the Bayh-Dole law also includes the government’s march-in right that allows the funding agency to effectively ignore the exclusivity of a patent awarded, and grant additional licenses to other reasonable applicants for an invention made using taxpayers’ funds, especially when it comes to achieving the health and safety of consumers.

 Bringing a useful drug to consumers is a complex process and typically involves many channels, from scientific institutions supported by federal grants, to research and development supported by private investors, and this can sometimes lead to contentious patent fights.  Moreover, one of capitalism’s cornerstones is the power of competition across the field. The WSJ can’t have it both ways when it embraces capitalism by citing the Bayle-Dole Act to support drug patent monopoly, while ignoring the other half of the law that would foster competition in drug development.

 At the time when drug cost inflation rate (15%) is the highest of all health sectors, our government has the moral obligation to stand up to Big Pharma, and the legal authority to bring regulations and enforce rules to make healthcare more affordable and available to all Americans.

 (Submitted on Dec 16; published in the GT on Dec 30, 2023)

Reflections on World Children's Day

Like many others, we have been watching the news of the Israel-Hamas war, everyday seeing images of fathers and mothers digging their infants from cement rubbles and craters, and entire communities in shock and despair beyond what we can ever imagine in our own lives. I also worry about how we are failing our children right in our own country, not for the lack of resources, but because we seem to have developed numbness to our own predicaments.  I needed to get my gut emotions out, without getting tangled in geo- or partisan-politics. This is finally what I could come up with.

 “In 1954, The UN designated November 20^th as “World Children’s Day” - to “offer each of us an inspirational entry-point to advocate, promote and celebrate children’s rights, and build a better world for children”. So how are we doing, nearly 70 years later? Or has the UN declaration remained but delusional buzzwords?

 Compared to those of the mid-20^th century, current statistics point to global improvements in many aspects of children’s health - mostly from better sanitation, nutritional and vaccination programs, and educational opportunities. However, more needs to be done in issues like child labor laws, gender equality and protection of girls. And tragically, an estimated 460 million children are living now in arm-conflicted zones, where 70-90 % of the casualties are borne by women and children.

 In the US, we have achieved mixed results. While the rate of reported illicit substance use has held steady, teen mortality is rising from more dangerous drugs; one in 5 teens suffers from clinical depression, and 20% of teens have seriously considered suicide. Gun violence is now the number one cause of death among American youth. Other disturbing reports: a recent increase in maternal and infant mortality rates; 17% of children experience food insecurity, 6% of children under age 6 are homeless. Rates are higher for racial minorities.

 I have confidence that our present world youth will find new technologies to mitigate the mess that we - their parents’ generation - have created: climate change, environmental pollution, or even the danger of unchecked artificial intelligence. But unless we have the political will to prevent or mitigate adverse childhood experiences (ACEs) now, we will continue to find ourselves in a cycle of complex PTSD that breeds despair or anger, and ultimately violence. ACEs are created when children, unable to navigate their own destinies, are caught at the intersection of social maladies that affect their families and communities: lack of decent housing and healthcare, low wages, racial discrimination, illicit drug use, crime, armed conflicts, and now a new scourge, social media disinformation. ACEs effects are life-long. Solutions are complex, yet basic in their principles. Charity is no substitute for social justice. Redressing the ACEs maladies is not a socialist agenda, but an investment in our shared social security and welfare.

 James Baldwin once stated: “Not everything that is faced can be changed, but nothing can be changed until it is faced” - a moral awakening that starts by examining how we all are interconnected to the problem - and to the solution. As Matthew Desmond pointed out in his book, “Poverty, by America”, many of us may be personally benefiting from systemic institutions that ubiquitously sustain financial inequities and poverty. Worldwide, we are by far the largest arm exporter, many of these weapons being used to indiscriminately kill civilians and children.

 If we can take pride in having landed on the moon and are now exploring the universe to find potential resources and places for mankind to expand, how can we ignore the most important investment right here, right now - our children? On this November 20, 2023, the theme for World Children’s Day is “For every child, every right”. The right to grow up safely, is it asking too much? 

 We all feel the consequences of childhood trauma and poverty left unattended. While a neglected child might become a “lone wolf” in our own neighborhood, or a future “terrorist” in a distant land, a child raised in loving care is, and will always be, a blessing for us all. So it is, the karma of our common humanity. Bless the children. All the children.”

(Submitted on Nov 7^th , published on Nov 14, 2023 in the Gazette Times, Corvallis)