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Tuesday, January 31, 2012

'Medicare for All' Would Solve California's Budget Deficit

Originally published on Calitics on January 31, 2012.

In Canada, the only way to see a doctor is to call one up and make an appointment. Or walk in to their office. In Britain, the only way you'll get surgery is if you actually need it. And yet State Senator Mark Leno and 44 co-sponsors want to bring this kind of healthcare system to everyone in California! Imagine.

In fact, the California legislature twice approved such a system, in which private providers carry on as independently as always but the public pays their bills directly (rather than indirectly as it does now, through a patchwork quilt of emergency care, programs to bring healthcare to the poorest and the elderly, and subsidies for insurance premiums.) Both times Governor Arnold Schwarzenegger vetoed the bill. But Senator Leno, a longtime campaigner for single-payer -- a.k.a. "Medicare-for-All" -- has brought the bill back again as SB 810. Last week, the bill fell just two votes shy of passage with a tally of 19-15 in favor. (It needs 21 to pass because it requires more than a simple majority.) Sen. Leno plans to push for another vote under Reconsideration, because several Democratic state senators abstained, but the deadline to win their support is today.

This single-payer bill is championed by Campaign for a Healthy California, a coalition which includes the California Nurses Association, Physicians for a National Health Program, California Alliance for Retired Americans, Progressive Democrats of America, California School Employee Association, Democracy for America, the California Health Professional Student Alliance, and many others. They have put out action alerts to supporters of SB 810 to call on five key state senators to vote Yes: Los Angeles area state senators Alex Padilla, Rod Wright, and Ron Calderon; San Diego area senator Juan Vargas, and Fresno/Bakersfield senator Michael Rubio. If supporters can bring just two of these state senators around in time for a Reconsideration vote today, then patients in California could very soon be able to choose which doctor to see (rather than submitting to a 'network' or their HMO). And the leading cause of bankruptcy for both the insured and uninsured - medical bills - could be eliminated.

A lot of people - i.e. all other advanced democracies in the world - think access to healthcare is a basic human right, and that organizing that access is one of the functions of a government and of a civilized society. In fact, in poll after poll, themajority of Americans support a publicly-funded universal health care system as well.

But never mind that. This is a time of economic struggle, an overstretched state budget, and financial uncertainty. Giving the government the job of administering health insurance at this particular juncture is above all else...the most fiscally conservative thing to do.

SB 810 would eliminate private health insurance entirely. All Californians' healthcare costs would be paid for from one big pool. It's just like the way people get insurance coverage now, except much much simpler, everyone would be covered, and the profit motive would be removed. And making health insurance a government-run program would dramatically reduce a huge portion of health care expenses that are eaten away by needlessly complicated administration costs. It's the exact opposite of what the bill's detractors pretend. Rather than creating more bureaucracy or paperwork, SB 810 would very quickly whittle down the costs of administering healthcare, currently at 33% of California's total healthcare spending, to under 5%.

Providers would only have to bill one entity, a new California Healthcare Agency, and would have no need to chase after patients for unpaid balances, or argue with insurers about whether the insured really does need that organ transplant or dialysis. That's how Sen. Leno's site can claim that SB 810 would save California $20 billion in the very first year by reducing administrative costs alone.

Moreover, health insurance commissioners would not need to watch over insurers and fight their premium hikes on behalf of consumers (health insurance premiums grow 4 times faster than wages). After SB 810, there would be no premiums. There would be no deductibles. There would be no co-pays. There would be no private health insurance.

These companies would still find a way to sell insurance for non-essential services -- just as in Canada insurers offer policies for things like private rooms should the insured be hospitalized. Insurance companies are nothing if not resourceful, and we shouldn't worry about them too much. The big change would be that with a single-payer program, insurance companies could no longer build their business by keeping the whole health system stratified.

The U.S. spends twice as much of its GDP on healthcare as other wealthy nations do. It spends more, and gets less. Americans receive less doctor consultations, hospital care, and surgery than people in other industrialized nations, yet our healthcare costs are higher. Insurance companies, by insisting on their privileged position as middlemen between patients and physicians, balloon healthcare costs out of all proportion. Far from delivering medical care more cheaply, these companies take money from patients - and from non-patients, like those who put off getting care because they can't afford their deductibles or co-pays but who keep sending in premiums to ward off catastrophe - and apply it to profit dividends, CEOs' bonuses and even marketing to win over more customers. And all we get in exchange is the 37th best healthcare in the world, according to the WHO.

In addition to Big Insurance, we have Big Pharma driving up healthcare costs. Countries like Canada began long ago to use the leverage of government to negotiate down drug prices, but in the U.S., the government behaves as if it is powerless in the face of whatever pharmaceutical companies wish to charge. SB 810 would tackle prescription drug pricing in California by using its bulk purchasing power. Sen. Leno estimates that such savings on medication, as well as equipment, would save the state $5.2 billion.

Lack of or inadequate insurance leads many to wait until their health is seriously threatened and then seek care in Emergency wards, rather than getting preventative screenings or catching the problem at the initial symptoms. This is not only costly to the hospital which provides the Emergency services, and to taxpayers who have to make up the costs, but it escalates costs in general, since by the time these patients seek care they are in need of much greater intervention. SB 810 would transfer the emphasis to preventative care and primary care, and thereby save Californians an estimated $3.4 billion.

In short, Sen. Leno maintains that SB 810 would be fully funded from the money we already spend on health care, and that, to boot, California would save a total of $29 billion just in the first year.

Considering that these cost-cutting measures would completely solve the state's fiscal crisis without either cutting social services or raising taxes, if Republicans really were fiscal conservatives they should have jumped on board with full support for SB 810. But of course insurance and pharmaceutical companies would be pretty unhappy with them, and campaign donations would stop flowing.

Since the Republicans' objections to the federal Affordable Healthcare Act was that it would force people to buy private health insurance - the result of the Obama Administration's barring single-payer advocates from all planning sessions - you would think that they would all be in favor of the freedom that SB 810 would bring. But of course it's hardly the freedom of the 99% that matters.

SB 810 has strong backing from ordinary, non-radical Californians. Sen. Leno's website lists 172 groups (unions and professional association, religious groups, city governments, Democratic Clubs, etc.) who endorse SB 810 and who have been working hard to make California the 2nd state in the nation to enact single-payer.

Single-payer advocates affiliated with the Campaign for a Healthy California include the American Medical Student Association, Consumer Federation of California, League of Women Voters of California, Progressive Caucus of the California Democratic Party, Amnesty International USA, California National Organization of Women, Courage Campaign, California Teachers Association, California Federation of Teachers, and California Faculty Association.

The bill's champions expect that Governor Jerry Brown would happily follow in the footsteps of Vermont's Governor Peter Shumlin and sign a single-payer bill. (The passage last spring of a publicly-run health insurance system made Vermont the first state in the U.S. to take this bold step.) If Sacramento fails to pass SB 810 this year because one Democratic senator voted No (Calderon) and four Democrats abstained (Padilla, Wright, Vargas, and Rubio), there will be a lot of very disappointed people in this state.

There will also continue to be 7 million Californians without insurance. Even after the federal Affordable Healthcare Act kicks in, 3 million Californians will remain uninsured, says Sen. Leno. Despite the fuss the country went through over health insurance reform, so-called 'Obamacare' would only manage to cover four out of five at best. And it is predicted that many who will still be unable to afford health insurance will choose to pay the fine instead. We will still have a tiered health care system. And we will stay pay more for less.

Thursday, January 12, 2012

Young Adult (2011)

This article was originally published on Political Film on Thursday, January 12, 2012:

When She Grows Up, She’s Going to Be Happy

by Jennifer Epps
The current print ad for Diablo Cody’s new comedy Young Adult shows Charlize Theron sporting uncombed hair and loungewear pajamas in an attempt to make her look disheveled and haggard – though this is of course an impossible task. It also bears a tag line meant to encapsulate the protagonist, Mavis Gary: “Everyone grows old. Not everyone grows up.” (The tag line in the trailer actually said, “Everyone grows older”, but some catty person in the publicity department seems to have corrupted it.) Now, Theron’s character is only 37. Is it even necessary to ask: if the main character were male, would anyone even think to call him old at 37? Or would the terminology be more along the lines of “immature,” “big kid”, “carefree,” or perhaps even “eligible bachelor”?
It should be noted, however, that this publicity does not accurately reflect the tone of the film. The title is our first clue that the subject of the film is prolonged adolescence: Young Adult refers to the category of fiction Mavis writes – for readers ranging from 14 to 21 – but it is also the way she sees herself. She cherishes freedom and spontaneity. She drinks daily and won’t eat properly. She is single in Minneapolis, lives in a high-rise apartment, and has few responsibilities. She carries a Pomeranian in her handbag, but neglects him and shows little affection for him. She is an expert at applying make-up, hair extensions, bra-stuffers, and a stunning wardrobe. She loves to get mani-pedis. She has pink accessories and Japanese kitsch-juvenilia. Her TV – even in hotel rooms – seems set on a default channel with nothing but programming about emotive young women who dream of being admired beauties. (Is there a Princess Channel?)
And Mavis is played, hilariously unrepentantly, by sharp-eyed Charlize Theron. This is no passive wallflower or ditzy elfin heroine we’ve seen many other actresses play in ‘chick flicks’. Instead, when an email announces the arrival of a baby to her now-married ex, she can’t let go of the one who got away. She jumps into her car for her small Minnesota home town without either saying goodbye to her date on the bed, or dressing. (Hence the casual attire of the movie’s poster.)

In high school, Mavis was envied by the girls and admired from afar by the boys – or, in the case of some lucky jocks, from very close indeed. Her problem is she never quite learned any other roles. She has never really stopped thinking like a prom queen. This makes her perfect for ghostwriting a long series of generic YA novels, but it doesn’t help her deal with reality. She is so busy fantasizing, scheming, and beautifying herself, she isn’t actually present – doesn’t notice, for instance, that her inarticulate, parochial ex (an unshaven Patrick Wilson) would not be a great match for her, even if he were available. She doesn’t even see him: she just sees the couple she wants to be.
This film has little interest in moments of chemistry between Mavis and Buddy, or in the rom-com scenario we may be led to expect. It has more interest in her struggle, and how her friendship grows with misfit Matt, the local Quasimodo who gives her sanctuary. (Drily played by Patton Oswalt, Matt is a short, overweight, fanboy who was attacked and almost killed in high school by homophobic jocks who believed he was gay.)
Yet what Young Adult has the most interest in is a character study of Mavis Gary.

She has actually been married – not to Buddy – and divorced as well. She feels like a failure, and her career is on a downward slide. She seems to have no close female friends, if we are to judge from the strained and superficial encounter between her and a gal pal early on, and she has no rapport with her parents – she checks into a hotel room in her home town without even thinking to tell them she’s back. (When she does go visit, we can see why. Her parents have instant denial reflexes about anything unpleasant, even when she does try to confide in them. There’s no there there.)
Though at first she comes off as the self-satisfied cheerleading-captain type we’re used to seeing, it soon becomes clear that she’s actually a complex character. The filmmakers do not delight in bringing ‘the smug, mean girl’ down a peg. She already is down, many pegs, when the movie starts. What’s quite a coup is that Young Adultcan create empathy for a hard-drinker who hates babies, won’t walk her dog, thinks ‘home-wrecker’ is a simple necessity of life, and mocks disability. (It’s not a crass, bad-taste comedy. It’s very humane; we feel for both her and her victims along the way.) And better yet, the film progresses from the humor of her thoughtlessness and delusions to something more philosophical, something more lingering: her inexplicable inability to figure out how to be happy.
Getting blotto nightly, passing out on the couch with the TV on, avoiding work on her novel as well as her editor’s phone calls, and obsessing over how to steal back a married man — this is an unusual leading role for a woman. While we’ve seen male anti-heroes wasting their lives on booze and procrastination before, especially in movies by or about Hunter S. Thompson, when screwed-up female drunks are on film, they are usually only someone’s neglectful mother — the cause of the protagonist’s problems, not the protagonist herself. Fortunately, as Theron’s track record already shows, when given quality material, she delivers – her seemingly effortless comedic timing has already garnered Golden Globe, Critics’ Choice, and Satellite Award nominations.
I do realize that literature and the performing arts have given us plenty of neurotic women. As in too many to do us any favors. But one reason they’re unhelpful is that men generally write them – memoirs of desirable but loopy women who break young men’s hearts, for instance. (Sometimes the woman is so loopy it’s a thriller, and she’s life-threatening. Or she’s suicidal – then it’s a drama.) Still, it would avail us nothing to demand that women in fiction always be centered, focused feminists who serve as role models; we do need to see characters face real problems, no matter what their gender. And Mavis is not, after all, complete fiction. She is the kind of woman Naomi Wolf worried in The Beauty Myth is likely to be the most brainwashed and the most deeply affected by cultural standards of female beauty – i.e. the kind of woman who meets them.
I believe screenwriter Diablo Cody and director Jason Reitman are taking aim at Mavis’ fantasy world and the values passed onto teen girls. Cody herself recently completed a commission to adapt the Sweet Valley High young adult novels for film. Like the invented Waverly series Mavis contributes to, SVH is a series of over 150 ghostwritten paperbacks about popular teenaged girls. The experience obviously fed Cody’s characterization of Mavis, who has a complicated relationship with her career: it encourages her arrested development, but it also distinguishes her from the less ambitious and creative people she grew up with in her small town.
That this is a reunion project for the makers of Juno, the wise-cracking Oscar-winning indie about a self-possessed teen with her own ideas about sex and relationships, should be evidence enough that Young Adult’s intentions towards Mavis are honorable. But to help bring it home, Cody and Reitman’s new film ends with “When We Grow Up” from the 1970’s feminist classic Free to Be…You and Me (a Ms. Foundation book, album, and TV special spearheaded by Marlo Thomas). Mavis’ growth is minor compared to rom-com tropes, and subtler, but it goes deeper. So, as the credits roll, we hear Diana Ross singing a children’s song about best friends, a girl and a boy, thinking about their futures and whether their genders will shape those futures. It’s a sweet song that still moves me.
“When I grow up, I’m gonna be happy and do what I like to do,
Like making noise and making faces and making friends like you.
And when we grow up, do you think we’ll see
That I’m still like you and you’re still like me?
I might be pretty; you might grow tall.
But we don’t have to change at all.”
Young Adult does not tie the story up with a bow the way Juno did. It is more willing to leave nagging questions unresolved. In short, Young Adult is more mature.