August 2009 Archives
08/28/09 10:30 AM
Welfare Dons
Remember the phrase "welfare moms?" It was a phrase designed to attack the very idea of government programs by suggesting that taxpayers all over the country were subsidizing people who were too lazy to work.
Well, in the current debate about health care reform, it may be time to coin a new phrase: Welfare Dons. They are the lazy, shiftless recipients of corporate welfare who have made America's health care system the most expensive and inefficient in the world. Let's take a look.
For some time, we have been told, in the words of Ronald Reagan, that government is not the solution; government is the problem. Private enterprise is good; government is bad.
But it's been getting confusing lately as free market fundamentalists, such as the Republican Michael Steele, have been touting the value of Medicare (a government program that happens to be popular), while denigrating government's ability to deliver good health care. There is a reason for this. In the eyes of most Republicans and some Blue Dog Democrats, Medicare is a $2.6 trillion-dollar piggy bank for the medical Welfare Dons: drug-producers, device-makers, medical conglomerates, insurance companies, and manufacturers of high-tech diagnostic equipment. By touting Medicare and denigrating government, the goal is to get government out of the business of protecting taxpayer dollars and hand over the keys to the Medicare piggy bank to corporations who want to be able to set high prices and mandate expensive procedures.
Don't believe me? Set the wayback machine to the passage of the Medicare Modernization Act, a bill that was literally written by lobbyists and passed by a determined Tom Delay and Billy Tauzin. (Yes, this is the same Billy Tauzin - another Welfare Don - who is now paid millions of dollars by Pharma and who was caught smiling - like a cat with a canary in its mouth - walking out of the Obama White house after saying he had cut a "deal" to keep government out of the business of forcing discounted prices.) In that bill, the federal government was prohibited from using its size and clout to negotiate with drug companies. Why? Well, that would have reduced profits and, oh yes, the cost of drugs. Instead, Medicare became a piggy bank that dispensed corporate welfare to Pharma in the form of high drug costs to US citizens. Yet Big Pharma doesn't really need our help; most of the big pharmaceutical firms take home profit margins of 16%.
But looting the public treasury for Pharma wasn't enough for the Welfare Dons. They also put in place a program for insurers called Medicare Advantage, a government hand-out of $16 billion (a trifle really) to compensate private insurers for the cost of offering Medicare to patients. In other words, the Welfare Dons took $16 billion from taxpayers to give to private insurers as a bonus for offering a government program! Then insurers hiked co-pays.
If you are a Welfare Don, how good is that! Now, just imagine how good it would be if you could keep taxpayer dollars flowing to Medicare but eliminate any barriers to how it is dispensed. What's that called? Killing the public option. Booyah! The fact is that, in a mixed system where private enterprise and public monies inhabit the same space, inefficiency and extravagance are profitable. Remember the military industrial complex? Private contractors make profits by charging the government for cost overruns. Defense contractors call this "cost plus." Pharma calls it "No Public Option."
Why is it that free marketeers are so afraid of competing with a government program which, in their religion, is inherently inefficient? Well who wants to compete with a public option that won't take 10-20% in overhead, lobbying costs, administration costs and profit? That's my bonus, dude. Whoops, I mean, I have a fiduciary responsibility to deliver the highest possible return to my shareholders.
And who wants to compete with a public option that won't just pay whatever drug-makers or others charge, without inquiring into the quality of the service or the product? Here's where the insurance companies really fail us. They over-pay hospitals, specialists and drug companies and then raise premiums to cover the costs. Further, when they pay hospitals 115% of what it should cost to care for a patient they are paying for inefficiency that can be dangerous. My mother, for example, went to a hospital for a simple procedure and died from an infection she caught there.
In the case of drugs, the problems can be even more troubling. To get discounts on some drugs, private insurers are willing to pay top prices for blockbuster pharmaceuticals like Vioxx, despite the fact that Vioxx was rumored to cause fatal strokes and heart attacks. Contrast this with the Veterans Administration (a government program that is actually interested in the welfare of patients) and the Mayo Clinic (a non-profit that worries about patients, not shareholders), both of whom stopped covering Vioxx for most patients more than a year before the manufacturer, Merck, was finally forced to take the drug off the market. And who did the forcing? It was that old, arcane, inefficient outfit that still worries about the public welfare, the government.
Welfare moms were mocked for doing nothing. The Welfare Dons are sensitive to charges of doing nothing (denying care to sick people, or people with preexisting conditions) so they have a slightly different m.o.: do something, even if it isn't necessary. Insurance companies pay big bucks for procedures but next to nothing for patient consultations and preventive medicine, which is what most medicine is. That's why - with the exception of what Don Berwick, from the Institute for Healthcare Improvement, calls "rescue care" (emergency surgery, radical cancer treatments, etc) - our health care outcomes are significantly worse than other fully industrialized nations even though we spend much more. More Ka-Ching! for the Welfare Dons.
But don't believe me. Ask the doctors who administer health care in this country. They speak in a new film that I produced, "Money Driven Medicine," which will air in a shortened form on "Bill Moyers Journal" on August 28.
Of course, one big difference between welfare moms and Welfare Dons is that the WDs are very politically powerful. And why is that? Well, our current Senators and congresspeople now spend up to half their time raising money for increasingly expensive elections. And who can supply that money? Why it's the Welfare Dons. This is where things get really good for the Welfare Dons. They can publicly denigrate government and show their contempt for it by treating it as a commodity that can be bought and sold. And what does the government do in return? It gives the Welfare Dons a big fat welfare check.
In criminal justice, this is called a protection racket. After all, while the term "Don" means a person of great importance, it also means the head of a crime family or syndicate. That's Welfare Don Corleone.
"The Godfather" was one of lobbyist Jack Abramoff's favorite films. That's the subject of my next film, "Casino Jack (and the United States of Money)."
08/08/09 3:54 AM
Heaven and Hell
My Apologies to those who have been wondering where my blog has been.
Fact is: I was filming the Tour de France for a documentary on Lance Armstrong I am directing for Sony Pictures. Yet, early in the morning on every stage, when I was supposed to be blogging, I was working on the editing of two other films I have been working on, "My Trip to Al Qaeda," based on a play by Lawrence Wright, and "Casino Jack (and the United States of Money)" about Jack Abramoff and the ongoing political corruption scandal in Washington. Now that the editing of "My Trip to Al Qaeda" has been finished, I can resume some blogging.
first up - the beginning of a blog I started in France, coupled with many pictures from the Tour.
Here I am with cinematographer Maryse Alberti ("The Wrestler," "Enron: the Smartest Guys in the Room"; "Taxi to the Dark Side") and Sound Recordist and Grand Prix Driver Rob Davis, on top of legendary Mont Ventoux. Note that we are facing away from the action...
What follows was originally written on July 11:
First of all, glimpsed from the window screens of our camera car, there are the trailers of heaven: scenes of Monaco; the cathedral of Gerona; the architectural wonders of Barcelona and the vista of Font de Magica high above the Plaza Espana; the craggy drama of Pyrenees. And this is just the beginning.
But filming the tour is some kind of hell.
We have seven cameras here. One is in the Astana Team car capturing the instructions to the riders of the legendary Directeur Sportif, Johan Bruyneel. One is on a motorcycle following the riders. Four are out on the course at various times and one is an extremely lightweight camera that we were able to put on the bike of one of the Astana team members (more on that later).
Every morning most of our team gathers to plan for the day. One crew usually starts filming at the Astana bus, where the crush of fans seeking a glimpse of Lance Armstrong is inexorable. The other crew gathers a bit of the daily circus around the starting gate. Jimmy Buffet, who made a brief cameo appearance in Barcelona, rightly calls the Tour Mardi Gras on wheels.
Out on road, things get complicated. The very best shots of the riders - head-on closeups - are mostly forbidden because a motorcycle in front of a rider can give him a draft. Also, for safety, the number of cars near the riders must be limited. So, every day, in two press cars, our two teams set out on the "Hors Course" - the side route - to find a fast way around to get ahead of the race course to secure camera positions for the fleeting moments when the riders fly by.
Care must be taken to avoid the Caravan Publicitaire, a nightmarish fleet of commercial floats, honking their horns, thumping bass-heavy music and showcasing hot young women throwing swag to drunken fans. In a reversal of the Odyssey's Sirens, these hotties are the ones who are harnessed, tethered to the posts under the plaster statues lest they go flying into the crowds when the float driver takes a wicked turn down a switchback.
The Caravan precedes the riders on the race course by an hour or so. In trying to find our camera positions, it's tough to weave in and out of the floats. So we try to precede the caravan. When we find a spot, we set up two cameras - usually one with a telephoto lens and one with a wide angle - to capture what we hope will be a "moment." We have a list of shots we are looking for - full peleton, breakaways, etc. - but we are also ready to capture whatever might happen.
Here's the drag. Once in a spot, we have to sit there for hours waiting for the race. Now that's not all bad. The fans are interesting - particularly if we catch them on a rising high before their stash of beers takes them to raucous oblivion. They come from all over and as far away as Australia. In Andorra, we met Basques, Catalans, French, Italians, Germans, Dutch...Yesterday, we positioned ourselves next to the van of El Diablo. He's a German "fan" who follows the Tour in his fan, getting smellier stage by stage.
During the time trial in Annecy, he got a French network car bounced from the tour when he hitched a ride and then mooned the crowd in front of the race director. In the pictures below, you can see him sneak his way into a photo of me and the former editor (he's been kicked upstairs at Rodale Publishing) of Bicycling Magazine, Steve Madden.
Here's the start of a picture gallery:
Stage One - Monaco - Lance Armstrong in the daily crush of reporters and his fans:
Monaco. Lance Armstrong, in his hotel room, after his ride in the Prologue, watching Alberto Contador on his ride:
The mass of bikes in Montpellier.
More later...
Alex Gibney
