(Photo by Robin Holland)

This week on the JOURNAL, guest host Lynn Sherr talked with Rory Stewart, an expert on Afghanistan and director of the Carr Center for Human Rights Policy at Harvard University, for his perspective on America’s lengthy war in that fractured country.

In a recently leaked memo, the United States’ top commander in Afghanistan, General Stanley McChrystal, recommended that the Obama administration send tens of thousands of troops – or, he wrote, the mission “will likely end in failure.” Facing increasing skepticism about the war from Congress and the general public, President Obama has so far delayed his decision on troop levels.

Rory Stewart argued that our stated goals for Afghanistan – routing the Taliban, banishing al-Qaeda, and restoring a functioning government – are unrealistic. He believes that the United States should deploy a much smaller force devoted to stopping al-Qaeda from rebuilding a base in Afghanistan rather than risk provoking a public backlash against any presence there at all. Regardless of what President Obama may personally desire, however, Stewart said that political and electoral pressures will likely compel him to deploy more troops:

“I think it's very irresponsible – if you care about Afghanistan – to increase troops much more, because I can see us going from engagement to isolation, from troop increases to total withdrawal. The path the President has started us on, I would predict, would mean that in five, six years time, everybody will simply get fed up with Afghanistan and abandon it entirely.... I think it would be a political catastrophe for the president to refuse to accede to a request from the man on the ground... He’s a civilian president... He’s under attack already from the right for being soft on national security... The General has provided his advice, and I would be extremely surprised if the President doesn’t come out in favor. In fact, my guess is that a lot of the talk about skepticism at the moment is an attempt to try to deal with opposition within his same party.”

What do you think?

Do you think Obama would sustain major political damage if he chose not to send more troops into Afghanistan? If so, should he send troops if it helps him pursue the rest of his agenda?

Tag(s): Afghanistan, democracy, governmentTag(s): Afghanistan, democracy, governmentTag(s): Afghanistan, democracy, government
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(Photo by Robin Holland)

In this week’s JOURNAL, guest host Lynn Sherr talked with Kavita Ramdas, President and CEO of the Global Fund for Women, about women’s contributions to building a better world.

Ramdas said:

“People are realizing [that] women and girls are not just simply victims, but are really standing up and are leaders in their communities and are standing up to be able to stand by us, the rest of the world, to make change... I just have stopped using that term, ‘women’s issues.’ I really don’t know what that is. What issues should 51 percent of the world check out on? Do we not care about peace and security? Do we not care about health and education? I think what we are talking about is the right of every human being, including the 51 percent that hasn’t had much voice for the past millennia, to be at the table to make decisions about the changes that we want to see in the world... Women are not just waiting to be filled up with resources – they’re ready to put their resources on the table to be able to lead towards a different world.”

What do you think?

Ramdas said that she no longer uses the term “women’s issues.” Is the term relevant to you? If not, what would you suggest?

Tag(s): women
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(Photo by Robin Holland)

This week on the JOURNAL, Bill Moyers spoke with author Sam Tanenhaus about his new book, The Death of Conservatism, and the current state of America’s conservative movement.

Tanenhaus suggested that today’s conservatism is mostly bereft of substantive ideas and instead consists of extreme reactions against the liberal social and policy agenda. He said:

“These radical people on the right – and they include intellectuals and the kinds of personalities we’re seeing on television and radio and also to some extent people marching in the streets – think America has gotten away from them. Theirs is a politics of reclamation and restoration... If you are a free-marketeer, or an evangelical, or a social conservative, or even an authoritarian conservative, you can all agree on one thing: you hate the liberals that are out to destroy us. That’s a very useful form of political organization. I’m not sure it contributes much to our government and society, but it’s politically useful and we’re seeing it again today... The paradox of conservatism is that it gives the overt signs of energy and vitality, but the rigor mortis I described is still there. As a philosophy, as a system of government that all of us can learn from as a means of evaluating ourselves, our social responsibilities, [and] our personal obligations and responsibilities, it has – right now – nothing to offer.”

Reviewing Tanenhaus’ book in THE NEW CRITERION magazine, Manhattan Institute senior fellow James Piereson argued that Tanenhaus ignores much conservative thought while castigating conservatives for failings that are also common among liberals. He wrote:

“Tanenhaus does not inquire seriously into the reasons why conservatives are uneasy with the welfare state, why some see in it a threat to liberty and others an encouragement to the breakdown of the family and self-government... He acknowledges that there is an important role for conservatism, but it must be a ‘genuine’ conservatism that preserves but does not seek to overturn liberal gains... Many of the sins Tanenhaus attributes to conservatives – overly zealous attachment to principle or ideology, unwillingness to adapt to change, impatience with popular opinion – are on display as much or more among liberals. If Tanenhaus or anyone else wishes to see liberalism in action, he might venture on to an elite college campus where only liberal and leftist views are permitted peaceful expression, or out to Sacramento or up to Albany where liberal Democrats, long in control, have spent their states into near bankruptcy... If conservatism is dead, in short, then so is liberalism, and much else besides.”

What do you think?

Do you expect conservatives to make a comeback in the next few election cycles?

Tag(s): America, democracyTag(s): America, democracy
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(Photos by Robin Holland)

In this week’s JOURNAL, Bill Moyers spoke with labor experts Michael Zweig and Bill Fletcher about the prospects for organized labor in the United States.

An annual Gallup poll conducted in August delivered sobering news to supporters of organized labor, finding that public approval of unions has declined to the lowest point in more than seventy years since the poll began:

“Gallup finds organized labor taking a significant image hit in the past year. While 66% of Americans continue to believe unions are beneficial to their own members, a slight majority now say unions hurt the nation's economy. More broadly, fewer than half of Americans -- 48%, an all-time low -- approve of labor unions, down from 59% a year ago... The 48% of Americans now approving of unions represents the first sub-50% approval since Gallup first asked the question in the 1930s. The previous low was 55%, found in both 1979 and 1981... There has been an even larger jump in the percentage saying labor unions mostly hurt the U.S. economy, from 36% in 2006 to 51% today.”

Michael Zweig said that organized labor has become overly willing to accommodate power rather than challenge it:

“The labor movement had a very militant, very aggressive stance in the '30s, '40s, '50s that challenged capital [and] that got tremendous benefits... Let's not forget, the labor movement is what got us the eight hour day and Social Security and all the other things that we think are so very important, but are just natural. That came out of a labor movement that was led and fueled by people who understood that there was antagonism, that there was a battle that they were involved in. This was not just, 'let's sit down and have lunch and figure out what's the best thing to do for America.' This was, 'here's a group of people who run the country and run businesses, and they have a certain set of interests and they do not have our interests at heart...' We have to be organized and be a contrary force that's a real force, that isn't just a debating society, that doesn't just have resolutions that it passes.”

Bill Fletcher said that organized labor needs to foster a broad social justice movement that looks beyond individual workplaces in order to gain more mass support:

“The question for organized labor is whether or not it can actually become a class movement, a movement of workers, and not simply unions representing people in different workplaces because I think that speaks to some of the anger that’s out there among workers who feel that they’re unrepresented [and] that the society is crushing them. They’re looking for a vehicle. They’re looking for someone to be their champion, someone to channel their anger. If it’s not unions, my fear is that right-wing populists are going to just grab onto this... We have leaders now that are paying more attention to getting access to political leaders or holding hands with the head of Wal-Mart rather than actually getting and inspiring workers, irrespective of whether they’re our members right now, to engage in a struggle for justice.”

What do you think?

Do you think labor unions have historically been good for America’s economy? Are they good for it today? Why or why not?

Tag(s): class, unions, workersTag(s): class, unions, workersTag(s): class, unions, workers
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(Photo by Robin Holland)

Below is an article by JOURNAL senior writer Michael Winship. We welcome your comments below.

"Let's Make a Deal: Beltway Edition"
By Michael Winship

If you ever needed proof that Washington is governed by the Golden Rule – the one that says, he who has the gold, rules – you only have to look at the wagonloads of cash being dumped by big business into crushing President Obama’s domestic agenda.

Good gosh, how the money rolls in. And I’m not only talking about the millions bankrolling the gang war over health care reform. A couple of weeks ago, THE WASHINGTON POST reported that the energy lobby is barnstorming around the country holding rallies and concerts, giving away free lunches and tee-shirts, spreading the wealth like a drunken oil tycoon – all to defeat the cap-and-trade climate bill that squeaked through the House and now awaits a vote by the Senate.

The paper noted that in the first half of the year oil and natural gas groups spent $82.1 million lobbying Capitol Hill – but that environmental, health and clean-energy interests scraped together less than a quarter of that amount, $18.7 million. Money talks, and it’s murmuring in your ear, “Global warming, what global warming?”

Those energy lobby high rollers in denial aren’t the only ones who know how to throw a party. Last month, Public Citizen, the consumer advocacy group that was founded by Ralph Nader, released an investigation of the ten banks receiving the most Federal bailout money plus five trade associations fighting government attempts to more closely regulate consumer banking.

In the period between Election Day last November and the end of June, the groups scheduled 70 fundraisers for members of Congress. Along the way, they made $6 million dollars in federal campaign contributions.

Thirty-five of those 70 wingdings – half! – were thrown by the US Chamber of Commerce and its lobbyists. And a third of the money contributed to candidates came from the American Banking Association and affiliated lobbyists. Both organizations are fighting hard to keep the government from clamping down on the financial industry. In fact, the Chamber of Commerce is planning on spending a hundred million bucks to keep the noses of federal snoops out of their business.

It’s not hard to figure out why they’re so eager to grease palms and throw the regulatory bloodhounds off the scent. On August 31, Bloomberg News reported that Wall Street is getting ready for a major battle to prevent tighter government control of the nearly $600 trillion dollar over-the-counter derivatives market.

According to Bloomberg, “Five U.S. commercial banks, including JPMorgan Chase & Co., Goldman Sachs Group Inc. and Bank of America Corp., are on track to earn more than $35 billion this year trading unregulated derivatives contracts. At stake is how much of that business they and other dealers will be able to keep.”

Astonishing to think about when you recall that just a year ago irresponsible derivatives trading was one of the reasons we were being sucked into the vortex of economic catastrophe. Equally astonishing to see the extravagant salaries banking executives are still raking in even while their foolish financial strategies made more and more of us eligible for the breadlines.

Recently, the Institute for Policy Studies, a progressive think tank, issued their annual executive compensation survey. This year’s is titled “America’s Bailout Barons.”

The institute took a look at paychecks for the top five executives at 20 financial companies – the ones that took the biggest helpings from the taxpayer-funded bailout buffet. From 2006 through 2008, they received an average of $32 million apiece – compensation packages that totaled $3.2 billion.

Just as a reality check, one hundred US workers making the annual average wage would have to work for more than a thousand years to make the money those hundred execs made in three.

Despite the financial crisis that nearly sank us a year ago, the front page of the September 12 NEW YORK TIMES reports that, “Backstopped by huge federal guarantees, the biggest banks have restructured only around the edges. Employment in the industry has fallen just 8 percent since last September. Only a handful of big hedge funds have closed. Pay is already returning to precrash levels, topped by the 30,000 employees of Goldman Sachs, who are on track to earn an average of $700,000 this year. Nor are major pay cuts likely, according to a report last week from J.P. Morgan Securities. Executives at most big banks have kept their jobs.”

If nothing is changed, MIT’s Simon Johnson, former chief economist of the International Monetary Fund, told the TIMES, the banks “will run up big risks, they will fail again, they will hit us for a big check.”

And look at this: while those executives are dancing with your dollars, the foreclosures they helped to bring on continue to rise. According to Moody’s Economy.com, nearly 1.8 million American mortgage holders will lose their homes this year – up from 1.4 million in 2008. And the Mortgage Bankers Association reports that the lion’s share of those foreclosures has shifted from the dreaded subprime mortgages that triggered this crisis to prime loans. That means people who were employed with sufficient income and security to take out a prime mortgage are losing their jobs and houses, too.

This jump in foreclosures is spreading nationwide to parts of the country previously not as hard hit, such places as Illinois, Idaho and Utah. In Oregon, where joblessness jumped to nearly 12 percent in July, foreclosures have skyrocketed 84 percent from a year ago.

So far, government programs intended to ease the hurt have had little effect. The Associated Press reported a month ago that despite a $50 billion mortgage bailout from Washington, only nine percent of the borrowers eligible for relief have seen their home loans modified.

Many of the banks involved have been dragging their feet, enjoying the bailout bucks but failing to spread them around. Some haven’t modified a single mortgage.

No wonder Rep. Barney Frank of Massachusetts, chair of the House Financial Services Committee, and Democratic Senate Whip Dick Durbin of Illinois are reviving the reform proposal that would allow bankruptcy judges to “cramdown” mortgage principal and interest rates to give homeowners some much-needed relief. Durbin said, “Waiting for banks to ‘volunteer’ to end this foreclosure crisis is a waste of time… This approach has failed miserably.”

Of course, you remember what happened the last time they tried to push “cramdown” through. Last spring, it was rejected by the Senate, 51-45. In anticipation of that vote, an exasperated Durbin told an Illinois radio station that, “The banks… are still the most powerful lobby on Capitol Hill, and they frankly own the place.”

Like what they’ve done with it?

Please note that the views and opinions expressed by Michael Winship are not necessarily the views and opinions held by Bill Moyers or BILL MOYERS JOURNAL.

Tag(s): Michael Winship
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(Photo by Robin Holland)

This week on the JOURNAL, public health expert Dr. Jim Yong Kim, who is also the incoming president of Dartmouth College, spoke with Bill Moyers about his vision of health and educational reforms for a better future. Dr. Kim commented on President Obama’s health care speech and the Republican response, and offered his suggestions for reforms that would benefit America’s dysfunctional medical system.

“As a speech, it was really stunning and masterful... But what was most interesting to me was the Republican response afterwards, and how many things that they seem to agree on... One, everyone should have health insurance. Two, we need to lower costs. Three, we need to maintain quality, [and four,] that the expenditures right now in health care, especially public expenditures, are unsustainable... There's no simple solution to this problem... For many, many years, we've been working under the fantasy that if we come up with new drugs and new treatments, we're done [and] the rest of the system will take care of itself... What we've learned about organizations is that it is very difficult to get a complex organization, a group of people, to work consistently toward a goal... What we need now is a whole new cadre of people who understand the science, who really are committed to patient care, but then also think about how to make those human systems work effectively.”

What do you think?

What neglected health reform ideas do you think should be included in health care legislation?

Tag(s): health
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(Photo by Robin Holland)

In this week’s JOURNAL, McClatchy DC’s Pentagon correspondent, Nancy Youssef, gave Bill Moyers an update on the turbulent situation in Afghanistan, where American troops have been deployed for nearly eight years. She addressed the recent controversy over the Associated Press’ decision to publish a photograph of a Marine mortally wounded in Afghanistan, Lance Cpl. Joshua M. Bernard, over the protests of his family and Defense Secretary Robert Gates.

Bernard’s father had argued that publishing the photograph would cause additional pain to the family, while Gates suggested that the publication violated “common decency.”

Santiago Lyon, the AP’s director of photography, defended the decision to publish the picture, saying “We feel it is our journalistic duty to show the reality of the war there, however unpleasant and brutal that sometimes is.”

Youssef expressed empathy for Lance Cpl. Bernard’s family and his comrades on the battlefield, but also emphasized that the public must be made aware of the violence of war.

“When that photo came out, I talked to a friend of mine who's a colonel in the Army. She served in Iraq, and many years ago she lost her daughter, who was a toddler at the time, to an illness. She could speak to it both as a soldier and as a parent. She was really angry about the photo and said, ‘No one has the right to tell me what my last memory of my child should be,’ and it really stayed with me... I think a lot of [soldiers] would be offended because it’s so personal. These are really guys that they were sitting next to the day before – it’s something to them that’s not for public consumption... But I'm conflicted, because as a journalist, and as someone who has to go out and see this war day in and day out, it's hard to say that these photos shouldn't be seen. In a way, I feel like the wars in Iraq and Afghanistan have been sanitized... It's really hard. You can't lose your humanity in war, and I feel for that father. I can't imagine that image being foisted upon me of my son in that position. I just can't imagine. But sometimes I feel that we as a public need to be hit almost violently with the reality of war, and that's what that photo does.”

What do you think?

How should journalists balance their responsibility to present the violent reality of war with honoring the wishes of fallen soldiers’ families?

Click here to view photo essays about the reality of war.

Tag(s): journalism, warTag(s): journalism, war
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We'd like to thank Maggie Mahar for agreeing to answer viewers' questions about the health industry. Below, in no particular order, is her second set of answers, while her first set of answers can be found here.

Please note that the views and opinions expressed are not necessarily the views and opinions held by Bill Moyers or BILL MOYERS JOURNAL.

------------------------------------

Q: A recent writer complained that she had paid "I think" 50 dollars for a two minute visit with a doctor who gave her a shot. Firstly, I find it hard to believe that a doctor spoke with her, probably took x-rays, and then gave her a shot in two minutes. Even assuming the doctor lunged at her with the injection as soon as he came in the room and the visit really did take 2 minutes- I'm not sure what her complaint is. Should she have been charged 10 or 20 dollars for an injection by a physician. Perhaps she would like to have paid in pennies.

Maybe I'm the one that is wrong, but yesterday I had an electrician over to my house. He charged me 200 dollars for ten minutes and he didn't even fix the problem. I paid him and thanked him for his time.

My point is that I believe some people have unrealistic expectations regarding personal health care costs. I realize doctors are held to a very high standard, but I never complain about their compensation. My wife had cancer and I paid all our copays and deductibles without a complaint. It hurt, but I was so happy to have trained doctors and nurses who could (and would) help us. I'm sure we have all had bad experiences with doctors, but on the whole I think we should all be careful what we wish for. Doctors could very easily opt out of all insurance (as many already have started to do) and charge whatever they want. Then there would really be a disparity in health care. Furthermore, if we continue to target doctors there will be less doctors staying in medicine. Why would anyone want to be in a profession where people complain about them, call them at 3 in the morning asking for their help, and then not want to pay them (and maybe even sue them)?.

-SL

A: Doctors’ pay varies widely by specialty. High-end physicians (neurosurgeons, orthosurgeons, urologists, radiologists, cardiologists) can make $500,000 to $850,000 a year—or more, sometimes much more--while physicians responsible for preventive and primary care (family docs, internist, pediatricians, palliative care specialists and psychiatrists) may earn as little as $115,000, and can expect, at the high end, no more than $275,000. Even ER docs — who may have your life in their hands — make only about $150,000 at the low end of the scale. (These numbers do not include bonuses or benefits—doctors who work for medical centers and other large entities often receive malpractice insurance as well as health benefits.) I’ve posted about this here: http://www.healthbeatblog.org/2008/01/health-care-spe.html.

Overall, we pay doctors more if they cut you or irradiate you, less if they talk to you and listen to you. We reward more aggressive, intensive medicine. This is in part because many specialties require more years of training, and when students emerge from that training they have tens of thousands of dollars in loans. (Other countries subsidize the cost of medical training; we don’t. Though the House bill currently under consideration would provide substantial loan-forgiveness for doctors who go into primary care, and Medicare would hike fees for primary care docs.)

But here’s the question: should a doctor who trains for 3 more years be paid six or seven times as much as other doctors, year after year, throughout a 30-year career? At what point has he been fairly compensated for the difference in the years of education? (I don’t have an answer to this question.)

Some would say that being an orthopedic surgeon is more difficult that being a geriatrician or a primary care doctor—that it requires more intelligence and skill. Others would say that treating elderly patients or trying to manage chronic diseases is, in its own way, just as challenging.
The other reason specialists earn so much more is because the RUC committee which adjusts Medicare’s fees every 5 years is made up primary of specialists—and not surprisingly, they consider specialists’ time worth more.

This committee meets behind closed doors and keeps no records of its meeting.. Many people have never heard of it, but it is incredibly powerful. (I have written about the RUC here http://www.healthbeatblog.org/2008/01/who-decides-how.html) The committee usually recommends raising fees, and rarely recommends lowering them — even though, thanks to new technology, some procedures have become easier and less time-consuming.

Medicare usually accepts its recommendations. Private insurers tend to follow Medicare’s fee schedule, though often they pay 5% or 10% more than Medicare.

Finally, when the Medicare fee-for-service schedule was set in the early 1990s, medical services were rated in terms of how much they cost the doctor in terms of: physical effort, mental effort, stress, number of years he needed to train to learn the procedure, number of minutes or hours it takes to perform the procedure . . . ..

Nowhere in the equation is benefit to the patient considered. So a doctor who spends 15 hours counseling a patient, and finally helps him stop smoking is paid far, far less than a doctor who spends 15 hours doing colonoscopies. Fifteen hours of colonoscopies may not save even one life (because most people don’t have colon cancer); persuading the patient to stop smoking may well save his life. But because we don’t count benefit to the patient, that second doctor is poorly paid.

(This is why there are many more heart surgery clinics in this country than there are smoking cessation clinics.)

This could change if Medicare begins to use “comparative effectiveness research” to raise fees for tests and treatments that provide the greatest benefit to patients who fit a particular medical profile, while lowering some fees for procedures that offer little or no benefit to those patients.

Q: Maggie, thanks so much for "MONEY-DRIVEN MEDICINE" film and thanks, Bill, for airing it on the JOURNAL. I am so disgusted with the conservative propaganda machine and likes of the "US Chamber of Commerce" from which I just got a flyer with a picture of a family of sourpusses that is SO distraught over the thought of "government bureaucrats making healthcare decisions". Like insurance company bureacrats are doing such a good job? I did a quick search about this organization and according to what I've found, it is a huge lobby paid for by the pharmaceutical and oil industries. And, judging by what I've seen in the media at the town halls, a lot of (non-informed) people are buying this propaganda. Horrors! Socialized medicine like what Canada and European countries have! Lower costs and longer life expectancy - we can't have that! It's not only the likes of the chamber, but politicians like Senators Grassley and Boehner that have spreading the half-truths. I know that one of the things that make our country great is access to information, but why is there no law against spreading misinformation as these lobbies and sentaors are doing? I am hoping that people who watch Pox (er, I mean Fox) News will watch PBS and your shows and get the real story. Thanks!

- Bruce Juntti

A: Bruce–

You are right. The people who try to spread fears about “government intervention in health care” ignore the fact that for-profit corporations interfere in the patient-doctor relationship. For instance, every direct-to-consumer drug ad that you see on television is telling a patient that he should tell his doctor: ”I want this product”. Yet the patient isn’t a physician, and short ad in TV is not going to give you the information you need. See this post on the problem and a possible solution: http://www.healthbeatblog.com/2009/08/a-solution-to-the-dtc-advertising-dilemma.html

As for all of the mis-information out there, some people are spreading what Hitler called “Big Lies.” Hitler wrote that if you tell a big lie (such as, “They’re going to pull the plug on Grandma!”), and tell it often enough, people will believe you.

If you tell a small lie, people may question it: “I wonder if that’s really true.”

But if you tell a really big whopper, people think “No one would say that unless it’s really true.” It is especially disturbing when our elected officials tell bald-faced lies.

Q: You would be well advised to stop reading so many books and talk to independant docs who are unrelated to hospital and insurance conglomerates and specialty syndicates.

- ChMyers

A: First, I agree that Medicare Part D was designed to serve the interests of for-profit insurers and pharmaceutical industries, not to serve the interests of patients. Health care reform is likely to cut back on the windfall payments to insurers, and to fill the “donut hole.” Ideally, traditional Medicare would offer Part D directly rather than farming the program out to for-profit insurers. And under the House bill now under consideration, Medicare would be authorized to use its clout to negotiate with drug-makers for discounts. The Veterans’ Administration already does this very successfully.

As for independent physicians—many of the doctors who appear in the film are independent physicians in private practice. Moreover, when I wrote the book, Money-Driven Medicine, I interviewed a great many physicians in private practice all over the country.

Many were frustrated that our health care system is broken—and that they didn’t have the power to fix it. A great many said something like: “I never thought I would say this . . . “ or “My father was a doctor and he must be rolling in his grave to hear me say this, “ but –I think we need the government to step in and help reform the system.” Only the government has the power to stand up to the corporate lobbyists and represent the public good.

But of course this will take political will and political spine. I am hoping that over the next 3 ½ years the White House and Congress will find that will.

Keep in mind, the legislation we pass this year does not mark the end of the game. Washington doesn’t plan to roll out universal health care until 2013. It will take that long to do it and do it right. Over the next 3 years, as we flesh out the details of reform, the debate will be intense.

Q: I am not sure I heard any nurse practitioners mentioned on the show. It seems to me that more RNs would get the training required to fill the void left by the shortage of primary care physicians. It also seems to me that clinics should be required to post rates for the cost of office visits and other standard care like minor illnesses and monor injuries so folks can get some idea of how costs compare at clinics in their area.

- Just Plain Roy

A: That’s a good point. When I wrote the book I reached out to nurses and nurse practitioners in many ways—on the web, by phone, etc. I wasn’t able to find a single nurse willing to talk to me on the record.

Even some physicians were nervous when talking to me: “Please, please don’t use my name. The politics in this business are such . . .”

And traditionally, nurses have been punished if they broke the silence and talked publicly about what they see in hospitals. Nurses know more about what is going on in our hospitals better than anyone else. There are too many errors, not enough nurses per patient, and too often nurses are multi-tasking. They don’t have the time to provide the patient care that they want to provide.

(I have heard this from doctors)

I agree that many nurse practitioners could provide primary care—or assist doctors proving primary care. Today, the shortage of nurses is caused, in part, by the fact that instructors in nursing schools are paid poorly. As a result, we have a shortage of nursing school teachers, and a long line of well-qualified candidates who would like training to become nurses. The House bill now on the table would raise salaries for nursing school teachers.

Tag(s): health
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(Photo by Robin Holland)

Below is an article by JOURNAL senior writer Michael Winship. We welcome your comments below.

"Marine's Photo Reminds Us of War that Will Not End"
By Michael Winship

There was a certain ironic and painful symmetry at work last month. As one iconic image of war was called into doubt, another was being created, a new photograph of combat’s grim reality that already has generated controversy and anger.

When it was first published in 1936, during the Spanish Civil War, Robert Capa’s photo was captioned “Loyalist Militiaman at the Moment of Death.” Better known today as “The Falling Soldier,” the picture purportedly captures the gunning down of a Republican anarchist named Federico Borrell Garcia who was fighting against the forces of General Francisco Franco. Dressed in what look like civilian clothes, wearing a cartridge belt, he is thrown backwards in an almost balletic swoon, his rifle falling from his right hand.

The picture quickly came to symbolize the merciless and random snuffing out of life in wartime – that murder committed in the name of God or country can strike unexpectedly, from a distance, like lightning from a cloudless sky.

Last month, the veracity of Capa’s most famous picture was cast in doubt when Jose Manuel Susperregui, a Spanish academic, published a book in which he alleges that the photo was not taken where Capa claimed, but 35 miles away at a location where no fighting had yet taken place; that the picture was posed, a fake. Others disagree, but his evidence is compelling.

Just as that controversy was being reported in the news, in Afghanistan another man lay dying, another victim of war. His photo created a sensation, too. But no one is questioning its veracity. In this case, the image is all too real.

During an ambush on August 14th, Marine Lance Corporal Joshua Bernard was hit by a rocket-propelled grenade in Afghanistan’s Helmand province, where the Marines have been engaged in a major offensive, fighting to take territory back from the Taliban. Associated Press photojournalist Julie Jacobson took a picture of comrades trying to save his life. But it was too late.

Over the objections of Bernard’s family and Defense Secretary Robert Gates, AP published the photo as part of a series of articles and photographs about Bernard’s platoon. Gates protested to AP that the wire service’s “lack of compassion and common sense… is appalling…” AP replied that it had made a tough decision to “make public an image that conveys the grimness of war and the sacrifice of young men and women fighting it.”

At BILL MOYERS JOURNAL, our production team wrestled with the dilemma over whether to show the photo on this week’s PBS broadcast. We finally decided to do so, but carefully placed it within the context of other pictures AP’s Jacobson took earlier that day of Lance Corporal Bernard and his fellow Marines on patrol.

However your own conscience comes down on this issue, there can be no denying the story the photo tells. It forces us to confront through a young man’s violent death the ugly, bloody reality of a war that America has been fighting longer than we fought in the First and Second World Wars combined.

August was the deadliest month for our troops in Afghanistan since we first invaded the country shortly after 9/11. It has been a gruesome summer – 51 Americans died in August; 45 in July.

And to what end? The Taliban is resurgent. Almost two-thirds of the country is deemed too dangerous for aid agencies to deliver much needed help. Civilian casualties this year have reached more than a thousand, including the victims of suicide bombings and so-called collateral damage from American air strikes. The credibility of recent so-called “free” elections has been shattered with charges of widespread fraud and corruption.

As THE ECONOMIST magazine noted last month, resentment against the Karzai government, NATO forces and Westerners in general is growing. “It seems clear,” the magazine reported, “that the international effort to bring stability to Afghanistan, in which a strong somewhat liberal and democratic state can take root, is failing.”

And yet, consider this open letter to President Obama from some of the very same neo-cons who used falsehoods, propaganda and manipulation to throw us into Iraq – arguing for invasion of that country even before the 9/11 attacks occurred. “We remain convinced that the fight against the Taliban is winnable,” they write, “and it is in the vital national security interest of the United States to win it.”

The letter lands just as several European countries have called for a conference to assess the current situation and the commander of our forces in Afghanistan, General Stanley McChrystal, delivers a review to the White House, a report many believe sets the stage for an even greater expansion of the war. But on Monday, the McClatchy news service reported that some top Pentagon officials worry without a clear definition of our mission there, further escalation may be useless.

According to the article, “Some even fear that deploying more U.S. troops, especially in the wake of a U.S. airstrike last week that killed and wounded scores of Afghan civilians, would convince more Afghans that the Americans are occupiers rather than allies and relieve the pressure on the Afghan government to improve its own security forces.”

One of that story’s reporters, McClatchy’s chief Pentagon correspondent Nancy Youssef, recently returned from Afghanistan and was interviewed by my colleague Bill Moyers for this week’s JOURNAL. Youssef said, “I can’t tell you how many Afghans said to me, ‘I don’t want the Americans. I don’t want the Taliban. I just want to be left alone.”

Nonetheless, “Either the United States commits to this and really commits to it, or it walks away. But this middle ground of sort of holding on isn't going to work anymore…

“We're at least coming to that decision point… And to me, that's good news, because at least it gives everybody involved some sense of where this is going. I think that's something worth looking forward to. Because what's been going on up until now is unacceptable.”

What no one understands for sure yet, she said, is President Obama’s position: “That’s the big mystery in Washington… Because it will ultimately be his decision.”

We should have a better idea of where he stands on September 24th, when the White House is supposed to present a list of metrics by which progress in Afghanistan will be measured, a condition that was set by Congress for the approval of further war funding.

In addition to the theories of generals and diplomats, the President and Congress may wish to pay careful attention to the words of an Afghan villager named Ghafoor. He told a correspondent for THE ECONOMIST, “We need security. But the Americans are just making trouble for us. They cannot bring peace, not if they stay for 50 years.”

Not a pretty picture.

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Before the terrorists struck on 9/11 I had been scheduled to speak to the Environmental Grantmakers Association on the impact of money in politics, one of my regular beats in journalism. When I went on the air with a daily broadcast after 9/11 I thought of canceling the speech, then five weeks away; it just didn’t seem timely to talk about money and politics while the country was still in mourning. But I began to notice some items in the news that struck me as especially repugnant amid all the grief.

President Bush had already urged us to prove our patriotism by going shopping. New York mayor Rudy Giuliani went on television to say we should “step up to the plate right now and show the strength of the American economy.” Giuliani himself would soon be hauling in a fortune exploiting his newfound celebrity to advise corporations on how to protect against terrorism. And in Washington the marionettes of the military-industrial-security complex salivated at the prospect of windfall profits rising from the smoldering ruins. Grief would prove no match for greed. I decided not to cancel the speech.

AFTER 9/11

Keynote address to the Environmental Grantmakers Association
Brainerd, Minnesota
October 16, 2001

This isn’t the speech I expected to give today. I intended something else.

For several years I’ve been taking every possible opportunity to talk about the soul of democracy. “Something is deeply wrong with politics today,” I told anyone who would listen. And I wasn’t referring to the partisan mudslinging, or the negative TV ads, the excessive polling or the empty campaigns. I was talking about something deeper, something troubling at the core of politics. The soul of democracy – government of, by, and for the people – has been drowning in a rising tide of money contributed by a narrow, unrepresentative elite that has betrayed Abraham Lincoln’s vision of self-government.

This, to me, is the big political story of the last quarter century, and I started reporting it as a journalist in the late 70s with the first television documentary about political action committees. I intended to talk about this today – about the soul of democracy – and then connect it to my television efforts and your environmental work. That was my intention. That’s the speech I was working on six weeks ago. Before 9/11.

We’ve all been rocked on our heels by what happened. We have been reminded that while the clock and the calendar make it seem as if our lives unfold hour by hour, day by day, our passage is marked by events – of celebration and crisis. We share those in common. They create the memories which make us a people, a nation with a history.

Pearl Harbor was that event for my parents’ generation. It changed their world, as it changed them. They never forgot the moment they heard the news. For my generation it was the assassinations of the Kennedys and Martin Luther King, the bombing of the 16th Street Baptist Church, the dogs and fire hose in Alabama. Those events broke our hearts.

For this present generation, that moment will be September 11th, 2001. We will never forget it. In one sense, this is what terrorists intend. Terrorists don’t want to own our land, wealth, monuments, buildings, fields, or streams. They’re not after tangible property. Sure, they aim to annihilate the targets they strike. But their real goal is to get inside our heads, our psyche, and to deprive us – the survivors – of peace of mind, of trust, of faith, to prevent us from believing again in a world of mercy, justice, and love, or working to bring that better world to pass.

This is their real target, to turn our imaginations into private Afghanistans, where they can rule by fear. Once they possess us, they are hard to exorcise.

This summer our daughter and son-in-law adopted a baby boy. On September 11th our son-in-law passed through the shadow of the World Trade Center to his office up the block. He got there in time to see the eruption of fire and smoke. He saw the falling bodies. He saw the people jumping to their deaths. His building was evacuated and for long awful moments he couldn’t reach his wife, our daughter, to say he was okay. She was in agony until he finally got through – and even then he couldn’t get home to his family until the next morning. It took him several days fully to get his legs back. Now, in a matter-of-fact voice, our daughter tells us how she often lies awake at night, wondering where and when it might happen again, going to the computer at three in the morning – her baby asleep in the next room – to check out what she can about bioterrorism, germ warfare, anthrax, and the vulnerability of children. Beyond the carnage left by the sneak attack, terrorists create another kind of havoc, invading and despoiling a new mother’s deepest space, holding her imagination hostage to the most dreadful possibilities.

The building where my wife and I produce our television programs is in midtown Manhattan, just over a mile from ground zero. It was evacuated immediately after the disaster although the two of us remained with other colleagues to help keep the station on the air. Our building was evacuated again late in the evening a day later because of a bomb scare at the nearby Empire State Building. We had just ended a live broadcast for PBS when the security officers swept through and ordered everyone out of the building. As we were making our way down the stairs I took Judith’s arm and was suddenly struck by the thought: is this the last time I’ll touch her? Could our marriage of almost fifty years end here, on this dim and bare staircase? I ejected the thought forcibly from my mind; like a bouncer removing a rude intruder, I shoved it out of my consciousness by sheer force of will. But in the first hours of morning, the specter crept back.

Returning from Washington on the train last week, I looked up and for the first time in days saw a plane in the sky. And then another, and another – and every plane I saw invoked unwelcome images and terrifying thoughts. Unwelcome images, terrifying thoughts – embedded in our heads by terrorists.

I wish I could find the wisdom in this. But wisdom is a very elusive thing. Someone told me once that we often have the experience but miss the wisdom. Wisdom comes, if at all, slowly, painfully, and only after deep reflection. Perhaps when we gather next year the wisdom will have arranged itself like the colors of a kaleidoscope, and we will look back on September 11 and see it differently. But I haven’t been ready for reflection. I have wanted to stay busy, on the go, or on the run, perhaps, from the need to cope with the reality that just a few subway stops south of where I get off at Penn Station in midtown Manhattan, three thousand people died in a matter of minutes. One minute they’re pulling off their jackets, sipping their coffee, adjusting the picture of a child or sweetheart or spouse in a frame on their desk, booting up their computer – and in the next, their world ends.

Practically every day the NEW YORK TIMES has been running compelling profiles of the dead and missing, and I’ve been keeping them. Not out of some macabre desire to stare at death, but to see if I might recognize a face, a name, some old acquaintance, a former colleague, even a stranger I might have seen occasionally on the subway or street. That was my original purpose. But as the file has grown I realize what an amazing montage it is of life, a portrait of the America those terrorists wanted to shatter. I study each little story for its contribution to the mosaic of my country, its particular revelation about the nature of democracy, the people with whom we share it.

Ivhan Luis Carpio Bautista: It was his birthday, and he had the day off from Windows on the World, the restaurant high atop the World Trade Center. But back home in Peru his family depended on Luis for the money he had been sending them since he arrived in New York two years ago speaking only Spanish, and there was the tuition he would soon be paying to study at John Jay College of Criminal Justice. So on the eleventh of September Luis Bautista was putting in overtime. He was 24.

William Steckman: For 35 of his 56 years he took care of NBC’s transmitter at One World Trade Center, working the night shift because it let him spend time during the day with his five children and to fix things up around the house. His shift ended at six a.m. but this morning his boss asked him to stay on to help install some new equipment, and William Steckman said sure.

Elizabeth Holmes: She lived in Harlem with her son and jogged every morning around Central Park where I often go walking, and I have been wondering if Elizabeth Holmes and I perhaps crossed paths some morning. I figure we were kindred souls; she too, was a Baptist, and sang in the choir at the Canaan Baptist church. She was expecting a ring from her fiancé at Christmas.

Linda Luzzicone and Ralph Gerhardt: They were planning their wedding, too. They had their parents come to New York in August to meet for the first time and talk about the plans. They had discovered each other in nearby cubicles on the 104th floor of One World Trade Center and fell in love. They were working there when the terrorists struck.

Mon Gjonbalaj: He came here from Albania. Because his name was hard to pronounce his friends called him by the Cajun “Jambalay” and he grew to like it. He lived with his three sons in the Bronx and was to have retired when he turned 65 last year, but he was so attached to the building and so enjoyed the company of the other janitors that he often showed up an hour before work just to shoot the bull. In my mind’s eye I can see him that morning, horsing around with his buddies.

Fred Scheffold: He liked his job, too – Chief of the 12th battalion of fire fighters in Harlem. He loved his men. But he never told his daughters in the suburbs about the bad stuff in all the fires he had fought over the years. He didn’t want to worry them. This morning, his shift had just ended and he was starting home when the alarm rang. He jumped into the truck with the others and at One World Trade Center he pushed through the crowds to the staircase heading for the top. The last time anyone saw him alive he was heading for the top. As hundreds poured past him going down, Fred Scheffold just kept going up through the flames and smoke.

Now you know why I can’t give the speech I was working on. Talking about my work in television would be too parochial. And what’s happened since the attacks would seem to put the lie to my fears about the soul of democracy. Americans rallied together in a way that I cannot remember since World War Two. In real and instinctive ways we have felt touched – singed – by the fires that brought down those buildings, even those of us who did not directly lose a loved one. Great and ordinary alike, we have been humbled by a renewed sense of our common mortality. Those planes the terrorists turned into suicide bombers cut through a complete cross-section of America – stockbrokers and dishwashers, bankers and secretaries, lawyers and janitors, Hollywood producers and new immigrants, urbanites and suburbanites alike. One community near where I live in New Jersey lost twenty-three residents. A single church near our home lost eleven members of the congregation. Eighty nations are represented among the dead. This catastrophe has reminded us of a basic truth at the heart of our democracy: no matter our wealth or status or faith, we are all equal before the law, in the voting booth, and when death rains down from the sky.

We have also been reminded that despite years of scandals and political corruption, despite the stream of stories of personal greed and lobbyists scamming the treasury, despite the retreat from the public sphere and the race toward private privilege, despite squalor for the poor and gated communities for the rich, we have been reminded that Americans have not yet given up on the idea of ‘We, the People.’ They have refused to accept the notion; promoted so diligently by right-wingers, that government – the public service – should be shrunk to a size where they can drown it in the bathtub, as Grover Norquist said is their goal. These right-wingers teamed up after 9/11 with deep-pocket bankers to stop the United States from cracking down on terrorist money havens. As TIME Magazine reports, thirty industrial nations were ready to tighten the screws on offshore financial centers whose banks have the potential to hide and often help launder billions of dollars for drug cartels, global crime syndicates – not to mention groups like Osama bin Laden’s Al-Qaeda organization. Not all off-shore money is linked to crime or terrorism; much of it comes from wealthy people who are hiding money to avoid taxation. And right-wingers believe in nothing if not in avoiding taxation. So they and the bankers’ lobbyists went to work to stop the American government from participating in the crackdown on dirty money, arguing that closing down tax havens in effect leads to higher taxes on the people trying to hide their money. The president of the Heritage Foundation spent an hour, according to the NEW YORK TIMES, with Treasury Secretary O’Neill, and Texas bankers pulled their strings at the White House, and presto! the Bush administration pulled out of the international campaign against tax havens.

How about that for patriotism? Better terrorists get their dirty money than tax cheaters be prevented from hiding their money. And this from people who wrap themselves in the flag and sing the Star Spangled Banner with gusto. H.L. Mencken got it right when he said that when you hear some men talk about their love of country, its a sign they expect to be paid for it.

But today’s heroes are public servants. Those brave firefighters and policemen and Port Authority workers and emergency rescue personnel were public employees all, most of them drawing a modest middle-class income for extremely dangerous work. They have caught our imaginations not only for their heroic deeds but because we know so many people like them, people we took for granted. For once, our TV screens have been filled with the modest declarations of average Americans coming to each other’s aid.

I find this thrilling and sobering. It could offer a new beginning, a renewal of civil values that could leave our society stronger and more together than ever, working on common goals for the public good. More than a decade ago, the playwright Tony Kushner wrote: “There are moments in history when the fabric of everyday life unravels, and there is this unstable dynamism that allows for incredible social change in short periods of time. People and the world they’re living in can be utterly transformed, either for the good or the bad, or some mixture of the two.”

This is such a moment, and it could go either way. Here’s one sighting. In the wake of September 11th there’s been a heartening change in how Americans view their government. For the first time in more than thirty years a majority of people say we trust the Federal Government to do the right thing “just about always” or at least “most of the time.” It’s as if the clock has been rolled back to the early sixties, before Vietnam and Watergate took such a toll on the gross national psychology. This newfound hope for public collaboration is based in part on how people view what the government has done in response to the attacks. President Bush acted with commendable resolve and restraint in those early days. But this is a case where yet again the people are ahead of the politicians. They’re expressing greater faith in government right now because the long-standing gap between our ruling elites and ordinary citizens has seemingly disappeared. To most Americans, government right now doesn’t mean a faceless bureaucrat or a politician auctioning access to the highest bidder. It means a courageous rescuer or brave soldier. Instead of representatives spending their evenings clinking glasses with fat cats, they are out walking among the wounded. In Washington it seemed momentarily possible that the political class had been jolted out of old habits. Some old partisan rivalries and arguments fell by the wayside as our representatives acted decisively on a fund to rebuild New York. Adversaries like Dennis Hastert and Dick Gephardt were linking arms. There was even a ten-day moratorium on political fundraisers. I was beginning to be optimistic that the mercenary culture of Washington might finally be on its knees in repentance.

Alas, it was not to be. There are other sightings to report. It didn’t take long for the war time opportunists – the mercenaries of Washington, the lobbyists, lawyers, and political fundraisers – to crawl out of their offices on K Street to grab what they can for their clients. While in New York we are still attending memorial services for firemen and police, while everywhere Americans’ cheeks are still stained with tears, while the President calls for patriotism, prayers and piety, the predators of Washington are up to their old tricks in the pursuit of private plunder at public expense. In the wake of this awful tragedy wrought by terrorism, they are cashing in.

How would they honor the thousands of people who died in the attacks? How do they propose to fight the long and costly campaign America must now undertake against terrorists?

Why, restore the three-martini lunch – surely that will strike fear in the heart of Osama bin Laden! You think I’m kidding, but bringing back the deductible lunch is one of the proposals on the table in Washington right now in the aftermath of 9/11. There are members of Congress who believe you should sacrifice in this time of crisis by paying for lobbyists’ long lunches.

And cut capital gains for the wealthy, naturally – that’s America’s patriotic duty, too. And while we’re at it don’t forget to eliminate the Corporate Alternative Minimum Tax, enacted fifteen years ago to prevent corporations from taking so many credits and deductions that they owed little if any taxes. But don’t just repeal their minimum tax; give those corporations a refund for all the minimum tax they have ever been assessed. You look incredulous. But these proposals are being pushed hard in Washington right now in an effort to exploit the trauma of 9/11.

What else can America do to strike at the terrorists? Why, slip in a special tax break for poor General Electric while everyone’s distracted, and torpedo the recent order to clean the Hudson River of PCBs. Don’t worry about NBC, CNBC, or MSNBC reporting it; they’re all in the GE family.

It’s time for Churchillian courage, we’re told. So how would the policies-that-be assure that future generations will look back and say “This was their finest hour?” That’s easy. Give coal producers more freedom to pollute. Shovel generous tax breaks to those giant energy companies. Open the Alaskan wilderness to drilling. And while the red, white and blue wave at half-mast over the land of the free and the home of the brave – why, give the President the power to discard open debate and the rule-of-law concerning controversial trade agreements, and set up secret tribunals to run roughshod over local communities trying to protect their environment and their health. It’s happening as we meet.

If I sound a little bitter about this, I am. The President rightly appeals every day for sacrifice. But to these mercenaries sacrifice is for suckers. I am angry, yes, but my sadness is greater than the anger. Our business and political class owes us better than this. They’re on top. If ever they were going to put patriotism over profits, if ever they were going to practice the magnanimity of winners, this was the moment. To hide now behind the flag while ripping off a country in crisis fatally separates them from the common course of American life.

Understandably, in the hours after the attacks many environmental organizations stepped down from aggressively pressing their issues. Greenpeace canceled its 30th anniversary celebration. The Sierra Club stopped all advertising, phone banks and mailing. The Environmental Working Group postponed a national report on chlorination in drinking water. That was the proper way to observe a period of mourning.

But the polluters and their political cronies accepted no such constraints. Just one day after the attack, one day into the maelstrom of horror, loss, and grief, many senators called for prompt consideration of the President’s proposal to subsidize the country’s largest and richest energy companies. While America was mourning they were marauding. One congressman even suggested that eco-terrorists might be behind the attacks. And with that smear he and his kind went on the offensive in Congress, attempting to attach to a defense bill massive subsidies for the oil, coal, gas and nuclear companies.

To a defense bill! What an insult to the sacrifice to our men and women in uniform! To pile corporate welfare totaling billions of dollars onto a defense bill in an emergency like this is repugnant to the nostrils and a scandal against democracy.

They’re counting on patriotism to distract you from their plunder. They’re counting on you to stand at attention with your hand over your heart, pledging allegiance to the flag, while they pick your pocket!

Let’s face it: the predators of the Republic present citizens with no options but to climb back in the ring. We are in what educators call “a teachable moment.” And we’ll lose it if we roll over. Democracy wasn’t cancelled on the 11th of September, but democracy won’t survive if citizens turn into lemmings. Yes, the President is our Commander-in-chief, and in hunting down the terrorists in Afghanistan who attacked us, he deserves our support. But we are not the President’s minions. If in the name of the war on terrorism President Bush hands the state over to the most powerful interests circling Washington, it’s every patriot’s duty to join the local opposition. If the mercenaries in try to exploit America’s good faith to grab what they wouldn’t get through open debate in peace time, the disloyalty will not be our dissent but our subservience. The greatest sedition would be our silence.

Yes, there’s a fight going on – against terrorists abroad, but just as certainly there’s a fight going on here at home, to decide the kind of country this will be during the war on terrorism.

During two recent trips to Washington I heard people talking mostly about economic stimulus and the national security. How do we renew our economy and safeguard our nation? Guess what? Those are the issues you are here to address, and you are uniquely equipped to address them with powerful language and persuasive argument.

If you want to fight for the environment, don’t hug a tree, hug an economist. Hug the economist who tells you that fossil fuels are not only the third most heavily subsidized economic sector after road transportation and agriculture but that they also promote vast inefficiencies. Hug the economist who tells you that the most efficient investment of a dollar is not in fossil fuels but in renewable energy sources that not only provide new jobs but cost less over time. Hug the economist who tells you that the price system matters; it’s potentially the most potent tool of all for creating social change. Look what California did this summer in responding to its recent energy crisis with a price structure that rewards those who conserve and punishes those who don’t. Californians cut their electric consumption by up to 15%.

Do we want to send the terrorists a message? Go for conservation. Go for clean, home-grown energy. And go for public health. If we reduce emissions from fossil fuel, we will cut the rate of asthma among children. Healthier children and a healthier economy – how about that as a response to the terrorists?

As for national security, well, it’s time to expose the energy plan before Congress for the dinosaur it is. Everyone knows America needs to reduce our reliance on fossil fuel. But this energy plan is more of the same: more subsidies for the rich, more pollution, more waste, more inefficiency. Get the message out.

Start with John Adams’ wakeup call. The head of National Resource Defense Council says the terrorist attacks spell out in frightful terms that America’s unchecked consumption of oil has become our Achilles heel. It constrains our military options in the face of terror. It leaves our economy dangerously vulnerable to price shocks. It invites environmental degradation, ecological disasters, and potentially catastrophic climate change.

Go to Tompaine.com and you will find the two simple facts we need to get to the American people: first, the money we pay at the gasoline pump helps prop up oil-rich sponsors of terrorism like Saddam Hussein and Moammar al-Quadaffi. Second, a big reason we spend so much money policing the Middle East – $30 billion every year, by one reckoning – has to do with our dependence on the oil there. The single most important thing environmentalists can do to ensure America’s national security is to fight to reduce our nation’s dependence on oil, whether imported or domestic.

You see the magnitude of the challenge. You understand the work that we must do. It’s why you must not lose heart. Your adversaries will call you unpatriotic for speaking the truth when conformity reigns. Ideologues will smear you for challenging their spin. Mainstream media will ignore you, and those gasbags on cable TV and the radio talk shows will ridicule and vilify you. But I urge you to hold to these words: “In the course of fighting the present fire, we must not abandon our efforts to create fire-resistant structures of the future.” Those words were written by the activist Randy Kehler more than ten years ago, as America geared up to fight the Gulf War. They ring as true today. Those fire-resistant structures must include an electoral system that is no longer dominated by big money, where the voices and problems of average people are attended on a fair and equal basis. They must include an energy system that is more sustainable, and less dangerous. And they must include a press that takes its responsibility to inform us as seriously as its interest in entertaining us.

My own personal response to Osama bin Laden is not grand, or rousing, or dramatic. All I know to do is to keep practicing as best I can the craft that has been my calling now for most of my adult life. My colleagues and I have rededicated ourselves to the production of several environmental reports that were in progress before September 11. As a result of our two specials this year – Trade Secrets and Earth on Edge – PBS is asking all of public television’s production teams to focus on the environment for two weeks around Earth Day next April. Our documentaries will anchor that endeavor. One will report on how an obscure provision in the North America Free Trade Agreement (NAFTA) can turn the rule of law upside down and undermine a community’s health and environment. Our four-part series on America’s First River looks at how the Hudson River shaped America’s conservation movement a century ago and, more recently, the modern environmental movement. We’re producing another documentary on the search for alternative energy sources, another on children and the environment – the questions scientists, researchers and pediatricians are asking about children’s vulnerability to hazards in the environment.

What does Osama bin Laden have to do with these? He has given me not one but three thousand and more reasons for journalism to signify on issues that matter. I began this talk with the names of some of them – the victims who died on the 11th of September. I did so because I never want to forget the humanity lost in the horror. I never want to forget the e-mail sent by a doomed employee in the World Trade Center who, just before his life was over, wrote his comrade: “Thank you for being such a great friend.” I never want to forget the man and woman holding hands as they leap together to their death. I never want to forget those firemen who just kept going up; they just kept going up. And I never want to forget that the very worst of which human beings are capable can bring out the very best.

I’ve learned a few things over a long life. I’ve learned that the kingdom of the human heart is large. In addition to the hatred at an Osama bin Laden, it contains courage. In response to the sneak attack on Pearl Harbor, my parents’ generation waged and won a long war, then came home to establish a more prosperous and just America.

We will follow in their footsteps if we rise to the spiritual and moral challenge of 9/11. Michael Berenbaum has defined that challenge for me. As President of the Survivors of the Shoah Visual History Foundation, he worked with people who escaped the Holocaust. Here’s what he says:

"The question is what to do with the very fact of survival. Over time survivors will be able to answer that question not by a statement about the past but by what they do with the future. Because they have faced death, many will have learned what is more important: life itself, love, family, community. The simple things we have all taken for granted will bear witness to that reality. The survivors will not be defined by the lives they have led until now but by the lives that they will lead from now on. For the experience of near death to have ultimate meaning, it must take shape in how one rebuilds from the ashes. Such for the individual; so, too, for the nation."

We are survivors, you and I. We will be defined not by the lives we led until the 11th of September, but by the lives we will lead from now on.

So go home and make the best grants you’ve ever made. And the biggest – time is too precious to pinch pennies. Back the most committed and courageous people and back them with media to spread their message. Stick your own neck out. Let your work be charged with passion and your life with a mission. For when all is said and done, the most important grant you’ll ever make is the gift of yourself, to the work at hand.

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(Photos by Robin Holland)

This week on the JOURNAL, Bill Moyers spoke with two prominent legal experts about an important case regarding campaign finance restrictions and free speech that the Supreme Court will hear in a special session on September 9th.

The case, Citizens United v. Federal Election Commission, concerns a political film, HILLARY: THE MOVIE, that criticized Hillary Clinton during last year’s bruising race for the Presidency. The conservative group Citizens United had planned to make the film available through on-demand cable and advertise it on television but, because the group had accepted contributions from businesses, the Federal Election Commission ruled that such distribution would violate campaign finance laws that ban the use of corporate money to advocate directly for or against political candidates.

Citizens United challenged the Federal Election Commission with a lawsuit that reached the Supreme Court in March. After hearing arguments, the Court took the unusual step of requesting that the case be re-argued at the special session next week. Many observers fear that the Supreme Court will declare unconstitutional many of the laws that aim to prevent corporations and unions from using their vast funds to influence political campaigns.

Floyd Abrams, a well-known progressive First Amendment lawyer, will argue before the Court against the current restrictions on corporations and unions. He said:

“There was a time back in the 1940s and 1950s when it was the liberals who were the ones saying, ‘Don’t go after the unions, they have a free speech right to put out pamphlets and the like to members urging them to vote for Franklin Roosevelt...’ That’s what I’m saying now... It’s all very well just to characterize this and diminish the problem by calling it just spending a lot of money. It’s more than that –– it is participating in the political process, it is speaking out, it is being heard... The First Amendment is not just the property of the press. The press deserves the broadest protection, but so do all other speakers... We should not make technical distinctions about the degree of First Amendment speech rights, depending on the nature of the entity that engages in the speech –– we [would] then go down the road to start defining press entities which will get the protection [and] speech entities which will not get the protection, and I don’t think that’s a place we want to be.”

Trevor Potter, former Chairman with the Federal Election Commission and General Counsel of John McCain’s 2000 and 2008 Presidential campaigns, has submitted a legal brief in support of existing campaign finance laws. He said:

“The Supreme Court has turned [this] into a case about whether 100 years of American tradition of regulating the speech of for-profit corporations in elections should be changed... That tradition [says] that individuals speak and vote and are citizens, and corporations have a different status and ought to be focused on the economic marketplace and not the political marketplace... Everybody has the ability to participate in the political process, meaning the election or defeat of candidates, except the for-profit corporations using shareholders’ treasury funds. That, it seems to me, is an appropriately narrow exemption given whose money that is, the shareholders’... [It’s a] dangerous and novel idea [that] we should change what has worked, what has been held constitutional, and go to a system when we have no idea what the effect will be. Based on what we can see, and have seen in the past, [it] could have some really bad effects on our democracy.”

What do you think?

Should campaign spending be seen as a free speech issue? Why or why not?

Tag(s): campaign, democracy, governmentTag(s): campaign, democracy, governmentTag(s): campaign, democracy, government
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We'd like to thank Maggie Mahar for agreeing to answer viewers' questions about the health industry. Below, in no particular order, is her first set of answers. More of her answers can be found here.

Please note that the views and opinions expressed are not necessarily the views and opinions held by Bill Moyers or BILL MOYERS JOURNAL.

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Q: Comparing Medicare Costs between NJ and Iowa: I suspect that the lower cost in Iowa is primarily due to the difference in re-imbursement rates for the same procedures, rather than fewer procedures.

-Ed Brown

A: Ed-

Thanks for your question. When comparing Medicare costs in Iowa and New Jersey, the Dartmouth researchers adjusted for differences in local prices as well as race, sex and the underlying health of the population. (They have been doing these regional comparisons for more than two decades so they have become very, very good at making adjustments that assure they are looking at apple to apple comparisons.) For their research see www.dartmouthatlas.org .

After making those adjustments, they discovered that costs were much higher in New Jersey —and they found out why. Looking at very similar patients in NJ and Iowa they discovered that patients in NJ were undergoing more tests and procedures, spending more days in the hospital, and seeing more specialists. Yet outcomes in NJ are no better. Often they are worse. Every treatment carries some risk of side effects when a patient undergoes an unnecessary procedure or an unnecessary hospitalization, he is exposed to risk without benefit. This is why over-treatment is hazardous to your health.

As Dartmouth’s Dr. Elliot Fisher puts it “Hospitals are dangerous places—especially if you don’t need to be there.”

The Dartmouth research also shows that patients are more likely to be over-treated (with no better outcomes) in areas where there are more hospital beds and more specialists. “Build the beds and they will come.” (Or, build the beds and someone will fill them.)

This is not to say that specialists consciously over-treat patients. It’s just that if there are more cardiologists in a particular town, they all have more time in their appointment books. And so they are likely to see a patient suffering from congestive heart failure every three months rather than, say, every six months. Similarly, if they know there are plenty of beds available, they are more likely to hospitalize that patient. And once she is in the hospital, other specialists will consult on the case, run some tests on her... and one thing leads to another.

When there is excess capacity—of beds, diagnostic equipment or specialists’ time --it tends to be used , whether or not it is needed.

I write about this here http://dartmed.dartmouth.edu/spring07/html/atlas.php and also in my book MONEY-DRIVEN MEDICINE.

Q: I'm looking, looking everywhere and can't find this info.

-Amy Jones

A: Amy-

A good question. This year, we as a nation, will spend roughly $2.6 trillion on healthcare. This includes the money that the government (i.e. taxpayers) shell out for care, as well as reimbursements from private sector insurers and the money patients spend out-of-pocket.

The list below shows where that $2.6 trillion winds up. (The numbers are complied by the Centers for Medicare and Medicaid Services).

Hospital Services: 31%
Physicians’ and Clinical Services 21%
Dental and other Professional Care 7%
*Prescription Drugs 10% (16%)
Home Health and Nursing Home Care 8%
Medical Equipment and other personal care 6%
Administrative Costs and Profits of Private Insurance 7%
Public Health Activities 3%
Research, Equipment, and Structures 7%

* “Prescription drugs—10%” includes only the drugs that you and I buy retail, in the pharmacy. If you include all of the drugs that are administered in hospitals, doctors’ offices, and nursing homes, as well as the many medical devices that pharmaceutical companies now sell (ranging from artificial knees to stents) drug-makers take in about 16% of our healthcare dollars. Those dollars show up on our hospital bills, doctors’ bills and nursing home bills, so in each case their share of the pie should be shaved by 1% to 2%

**Administrative Costs and Profits of Private Insurers: This represents the 15% to 20% of our insurance premiums that private insurers keep to cover their marketing, advertising and lobbying expenses, salaries of executives, the cost of “underwriting” (deciding how much to charge patients suffering from pre-existing conditions), all other overhead, plus profits for shareholders.
Because private insurers pay only about 36% of the nation’s $2.6 trillion in health care bills their administrative costs and profits take a smaller slice from the pie than many people think—7% of the $2.6 trillion. If they paid all healthcare bills, their share of the pie would be closer to 20%. But government (i.e. taxpayers) now covers roughly half of all healthcare bills through Medicare, Medicaid, SCHIP, and Veteran’s programs, while patients pay 14% out-of-pocket. If we expand health care insurance to cover everyone, private insurers hope to wind up covering a larger share of our healthcare bills; that’s why they don’t want to have to compete with a public insurance option.

Finally, you asked about insurance company profits. As the cost of healthcare spirals, private insurers’ reimbursements to doctors, hospitals and patients have been climbing by roughly 8% a year for the past ten years. See chart on p. 2 of this report: http://www.tcf.org/Publications/Healthcare/Maggie%20Agenda.pdf .

Insurers have been scrambling to pass these rising costs on to patients in the form of higher premiums; this explains why your premiums have been spiraling. But as insurance becomes more and more unaffordable, insurers have been losing customers—while paying higher bills.

As a result, industry profit margins are only about 3%, putting insurers far behind other industries. See this post http://www.healthbeatblog.com/2009/08/who-is-making-the-biggest-profits-from-us-healthcare-you-might-be-surprised-.html#comments .

Q: I seem to be the only American to see that it is not an insurance problem. It is a cost problem for the services rendered. In 2005 I had a sleep study, a one night stay at a clinic to check for Sleep Apnea. The bill submitted to my medical insurance carrier was $3300.00. A friend of mine had the same study at a different facility around the same time period and his insurance was billed over ten thousand dollars. This is in the realm of the $1200.00 oil change for your vehicle, or $75.00 for a gallon of milk. I call our present system “Greedcare”. The current healthcare bill that is proposed from all indications is to perpetuate the high cost for procedures and impose high taxes on everyone. The old argument is still in place which I believe to be a lie that the costs are high because of the past, not collecting money from others who did not pay their bills. If this is the case to some degree, they need to clean the slate and start over when a real healthcare coverage system the could be enacted that does cover everyone so that the next time someone has a sleep study like it did it would cost only $250.00 tops, and the cost would be paid by a real healthcare plan that does not rip anyone off, or intrude into our lives. Maggie, why can’t this happen? Why can’t they take the greed out first and then talk about insurance covering Americans?

-Mike Boxell

A: Mike-

You are right: we do pay more than the citizens of every other advanced country for virtually every medical service and product. (And this is after adjusting for differences in cost of living.) Moreover, different providers will charge insurers vastly different prices — depending on what deals they have cut with the insurers.

Why? Because we are the only country in the developed world that has chosen to turn healthcare into a largely unregulated for-profit enterprise. In other countries, governments negotiate with drugmakers for discounts. They regulate pricing in many areas, and cap how much patients can be charged. In some countries regional administrators negotiate fees or salaries with health care providers. Often, physicians are on salary, or are paid a lump sum to keep a patient well, rather than being paid “fee-for-service.” By paying doctors “fee-for-service” we are reimbursing them as if they were factory workers on an assembling line, creating perverse incentives to “do more”.

Some governments put a limit on how many doctors are trained in a particular specialty, putting more emphasis on training primary care physicians. This means that people receive more preventive care and better management of chronic diseases, while seeing fewer specialists. Medical research shows that when patients receive more primary care, and see fewer specialists, outcomes are often better — and costs are lower — both in the U.S. and in Europe.

Finally, other countries subsidize medical education. In the U.S. medical students leave school with enormous loans, which means they must charge more, just to pay off those loans while simultaneously launching a career, and, in many cases, starting a family.

Why haven’t we followed the example of other countries and found ways to rein in health care spending? The truth is that a great many people are making fat profits in the present system. Drug-makers’ profit margins, for instance, average around 16%. (I’ve written about this here http://www.healthbeatblog.com/2009/08/who-is-making-the-biggest-profits-from-us-healthcare-you-might-be-surprised-.html. Some hospitals charge private insurers 115% to 120% of what it actually costs them to care for patients. (See this post http://www.healthbeatblog.com/2009/08/does-medicare-underpay-hospitals-.html. Insurers pass on the cost in the form of higher premiums.

Meanwhile, brand-name hospitals invest in hotel-like amenities, marble lobbies, waterfalls, atriums and mahogany paneled conference rooms for physicians. We’re all paying for this—and we really can’t afford it.

But in order to rein in spending, politicians are going to show some spine and take on the lobbyists who represent those making enormous profits on our healthcare system.

Other countries recognize that health care is a necessity—like heat and light—and thus, the industry needs to be regulated, the way the U.S. used to regulate gas & electric companies. (When we decided to de-regulate that sector, we wound up with Enron.)

Q: I know someone who's always going on about tort reform. Do malpractice suits really have that much effect on healthcare costs?

-Cathy Lester

A: Cathy-

There are two ways that malpractice suits add to the cost of healthcare. First, we all wind up paying the cost of malpractice awards and settlements. Malpractice insurance companies factor the cost into the premiums they charge health care providers; hospitals and doctors pass the cost along to patients. But the total cost of malpractice settlements and awards equals only about 0.5 percent of the $2.6 trillion that we spend on health care. It’s just not a big factor...

But those who argue for tort reform that would limit malpractice awards argue that “fear” of malpractice suits is a much bigger problem: This fear causes doctors to order unnecessary test and treatments in order to protect themselves.

In truth, it is impossible to quantify how much “defensive medicine” adds to the cost of care. When a doctor orders a procedure or sends a patient to the hospital he usually has four or five reasons. Fear of a lawsuit may well be one of them. But in most cases, not even the physician himself could untangle his motives, or say which one is driving the decision.

What we do know is that in states that have capped malpractice awards, over-treatment continues. Texas is a good example. (See Dr. Atul Gawande’s article in the June 1 NEW YORKER at http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande as well as www.dartmouthatlas.gov)

There are other, better solutions to the fear of malpractice suits. I’ve written about malpractice here: http://www.healthbeatblog.org/2008/05/medical-malpr-1.html and http://www.healthbeatblog.org/2008/05/medical-malprac.html .

Q: While I appreciate the critique of the medical system, which I understood to be medicine based on capitalism, I did not perceive reasonable solutions. One cannot merely make for-profit insurance illegal. Perhaps you could explore TR Reid's ideas on not-for-profit coverage. How would we transform our profit systems for a non-profit? What would the laws have to dictate? Would such a change be Constitutional?

-Dave Searcey

A: Dave-

Mainly people don’t realize that before 1980, most health insurers were non-profit. In 1981, only 12% were for-profit. Up until then, the government, which wanted to encourage non-profit insurers, made federal grants and loans available to them.

But after Ronald Reagan was elected in 1980, he cut off that stream of federal funding. Meanwhile, for-profit insurers saw how quickly health care spending was spiraling, and realized that non-profits no longer had help from the government. For-profit insurers decided that might be able to take over an increasingly insurance lucrative market—and they did just that. By 1986 the share of non-profit insurers had fallen to 41 percent and by the 1990s for-profit insurers controlled the industry.

We don’t need legislation — or a change in the Constitution — to transform the market place for health insurance. Both President Obama and the health care legislation now in the House calls for a public sector insurance option that would be much like Medicare (while incorporating the reforms that Medicare is now planning to raise quality and lower costs.) Beginning in 2013, individuals who wanted to would be able choose this public plan (I call it Medicare E, Medicare for Everyone)—or they could choose a for-profit insurance plan. It would be up to them.

Most likely the public plan would be less expensive than private insurance because it wouldn’t have to lobby Congress, or invest huge sums in marketing and advertising. It wouldn’t have to pay executives seven-figure salaries, or provide profits for investors. If it offered good quality care, over time, more Americans might well choose the public plan.

Some people would prefer to see a single-payer system now. But many Americans who have employer-sponsored insurance want to keep it; they don’t want to be forced into a government plan that they have never seen. There is, I think, much to be said for giving people a chance to see a public sector plan in action, and then choose it, if they wish, rather than feeling that they are being corralled into a public plan.

In the meantime, the public plan could set a high bar for quality care at an affordable price. For-profit insurers would have to try to match that benchmark. Some for-profit insurers would have trouble competing; it would depend on how innovative they were.

Non-profit insurers in the private sector like Geisinger or Kaiser Permanente would be likely to do well in this context—they are already more like a government plan.. They have no shareholders, and the best non-profits put a real emphasis on providing high-quality care. It seems to me a good idea to have some private sector insurers as alternatives to the government plan. What if Jed Bush is elected president in eight years? Think of what Margaret Thatcher did to the UK’s single-payer system when she became prime minister.

I’ve written about the importance of the public sector option here: http://www.alternet.org/healthwellness/141040/only_a_public_option_can_make_decisions_in_patient's_best_interest/.

Tag(s): health
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(Photo by Robin Holland)

Below is an article by JOURNAL senior writer Michael Winship. We welcome your comments below.

"Coming Soon to a Democracy Near You..."
By Michael Winship

The envelope, please. And the winner for “most influential motion picture in American politics” is… HILLARY: THE MOVIE.

Never heard of it? Not surprising – very few people saw it in the first place. But HILLARY: THE MOVIE – a no-holds-barred attack on the life and career of Hillary Clinton intended for viewing during her presidential campaign – could prove to have an impact on the political scene greater than even its producers could have dreamed.

In the world of money and politics, HILLARY: THE MOVIE may turn out to be the sleeper hit of the year, a boffo blockbuster. Depending on the outcome of a special Supreme Court hearing on September 9th, this little piece of propaganda could unleash a new torrent of cash flooding into campaigns from big business, unions and other special interests. HILLARY: THE MOVIE may turn out to be FRANKENSTEIN: THE MONSTER.

The film was created by a conservative group called Citizens United. They wanted to distribute the film via on-demand TV and buy commercials to promote those telecasts, but because the film was partially financed by corporate sponsors, the Federal Election Commission said no, that it was a violation of the 2002 Bipartisan Campaign Reform Act – McCain-Feingold – which restricts the use of corporate money directly for or against candidates.

Citizens United appealed their case all the way to the Supreme Court, where it was first heard back in March. But the court did an usual thing. They asked for more time and ordered a new hearing and new arguments, almost a month ahead of the first Monday in October that usually marks the official start of the court’s annual sessions.

The reason for the special hearing is to more broadly consider the constitutionality of McCain-Feingold and campaign finance reform in general; whether it denies a corporation the First Amendment right of free speech.

Those who believe that a corporation is being deprived of a fundamental right feel it should be treated no differently than any individual citizen. Those opposed believe that corporations do not hold the same rights as citizens and that their deep pockets – via political action committees (PAC’s) and other avenues of participation – already give them clout and influence dangerous to the health of a democracy.

All of this comes, as THE NEW YORK TIMES reported, “At a crucial historical moment, as corporations today almost certainly have more to gain or fear from government action than at any time since the New Deal.”

More than 50 friend of the court (amicus) briefs have been filed, an unprecedented number for a First Amendment case. The legal wrangling has made for some strange pairings. “The American Civil Liberties Union and its usual allies are on opposite sides,” the TIMES noted, “with the civil rights group fighting shoulder-to-shoulder with the National Rifle Association” in support of HILLARY: THE MOVIE’s corporate sponsors.

“Most of the rest of the liberal establishment is on the other side, saying that allowing corporate money to flood the airwaves would pollute and corrupt political discourse.”

One of those who will argue on September 9th for overturning the McCain-Feingold limitations is the redoubtable Floyd Abrams, the ardent and vocal defender of free speech who has argued many landmark First Amendment cases before the Supreme Court. On the other side is Trevor Potter, founding president of the non-partisan Campaign Legal Center and a former chairman of the Federal Election Commission. General Counsel to John McCain during his presidential campaigns in 2000 and 2008, Potter was involved in the drafting of McCain-Feingold and has filed one of the amicus briefs in its defense.

Both appear on the current edition of public television’s BILL MOYERS JOURNAL, interviewed by my colleague Bill Moyers. “The question here is to what extent, if at all, can unions and corporations spend their money to put ads on or to speak out themselves in their own name about political matters, including even who to vote for,” Abrams said.

“I don't think that we should make a distinction on First Amendment grounds in terms of who's speaking. I think that whether the speaker is an individual or an issue group or a union or a corporation, if anything, the public is served, not disserved, by having more speech.”

Trevor Potter disagreed. “Corporations exist for economic purposes, commercial purposes,” he said. “And the notion that they have full First Amendment free speech rights, as well doesn't make any sense for this artificial creation that exists for economic, not political purposes…

“Corporations just want to make money. So, if you let the corporation with a privileged economic legal position loose in the political sphere when we're deciding who to elect, I think you are giving them an enormous advantage over individuals and not a healthy one for our democracy.”

The Supreme Court could rule just on Citizens United’s HILLARY: THE MOVIE case, but the call for the special session and the current composition of the court would seem to indicate that the decision might completely overthrow McCain-Feingold.

Three thousand corporate PAC’s registered with the Federal Election Commission in 2007 and 2008 spent more than $500 million for political purposes. And we’ve seen the hundreds of millions big business already has spent to battle the Obama administration’s domestic agenda. A 5-4 decision in favor of corporate interests could mean much, much more money from multinational corporations overwhelming our electoral process.

Think of the September 9th hearing as a sneak preview of coming attractions.

Please note that the views and opinions expressed by Michael Winship are not necessarily the views and opinions held by Bill Moyers or BILL MOYERS JOURNAL.

Tag(s): Michael Winship
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