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American Pragmatism & the Health Care Crisis by Gerry O'Shea

by Call To Action on 07/24/17

The American way of solving problems is often spoken of as pragmatic. In this approach the truth of any idea is determined by its practical outcomes. Every proposal is viewed not through the prism of some theoretical principle or dogma but is judged solely on its actual impact on people's lives.

Consider the American health care system and, for now, leave aside any consideration of ideology and assess the way we deal with this vital issue strictly from a pragmatic viewpoint where only results matter.

The annual per capita spending for health care in the United States comes to $9451, but about 40 million people have no coverage of any kind. After all that spending, you might expect that American life expectancy of 79 years would be at the top of the international ratings. Not so. In our nearest neighbor, Canada, where everybody is covered at a cost of $4608 per person, longevity is 82 years.

A few more examples highlighting cost and extent of coverage in other Western democratic countries are instructive. In Germany where people on average live to the age of 81 and health insurance is mandated for everybody, the per capita cost is $5267. In Japan the cost per person for health insurance is $4150 and, on average people live five years longer than in the US - again universal health insurance is required by law there.

Staying with pragmatic considerations, how do the millions of uninsured people manage in the United States? They get no preventive care, no check-ups which often identify medical problems early and allow for lifestyle changes or palliative medications. So when they get sick they are rushed to the nearest emergency room where the cost of treatment is at a premium.

Economic and practical considerations alone strongly indicate that having  tens of millions of uninsured people who can't afford preventive care is a very inefficient and wasteful way to organize a health coverage system.

Where is the famous American pragmatism which works in many other areas of the economy? We are paying far more than other Western countries but living shorter lives, and tens of millions of our citizens have no medical coverage. Leaving aside for now  humanitarian considerations, just from a business point of view, this is a dreadful deal.

President Trump and most of his cabinet are billionaire business people. We were told repeatedly during the Presidential campaign about all the problems that the Obama and Bush leadership teams failed to solve because of incompetence. Stand back and just watch how the super-rich apply business acumen to running the country.

Obamacare was and still is their first big  bete noir and candidate Trump  promised daily to scrap it. However, in doing so he promised that  there would be no cutbacks in Medicare or Medicaid  and somehow deductibles and co-payments would also be trimmed. Trumpcare would increase the number of people covered while ending the Obama mandate that required all citizens to buy health insurance.

Well the Healthcare Bill that passed the House of Representatives with the enthusiastic support of the White House, according to the independent Congressional Budget Office, would end coverage for over 22 million people by massively reducing federal Medicaid payments to the States. The President was elated that the Bill passed, and he invited all the House Republicans for an unprecedented celebratory drink in the White House.

A few weeks later as he tried to persuade moderate Senators to vote for Senate leader McConnell's proposals, he called the House effort "mean." Then he tweeted that Obamacare should just be repealed and the messy business of replacing it could be dealt with at a later date. That would result in 32 million being removed from coverage. Honestly, you can't make this stuff up!

Pulling back from all this talk about fixing or replacing Obamacare, one has to ask why the United States, the most powerful and richest country in the world, doesn't have a health care policy that covers all residents. The other Western democracies cover all their citizens, irrespective of age or income.  Why is America different?

Excluding millions who can't afford to pay insurance premiums does not meet acceptable humanitarian standards. The present inhumane policy of the survival of the fittest demeans our democracy.

Obamacare, while well short of providing  universal care, brought coverage to millions previously uninsured. All the emerging Trumpcare proposals instead of expanding the numbers covered have the very opposite effect.

More than 80% of evangelical Christians and close to 60% of non-Hispanic  white Catholics supported Trump last November. Yet I see no evidence of a Christian influence in White House policies, especially in this vital area of life and death for so many where the poor are really vulnerable.

Adding insult to injury, the money saved in Medicaid, which mostly helps the poor, by any version of the Republican proposals goes mostly in massive tax savings for the rich. This is not hidden or camouflaged in any way - Robin Hood in reverse in broad daylight. The amount involved hovers around 700 billion.

Maybe we should set aside moral considerations about  Trumpcare  and not consider the repeated biblical injunctions about how the poor should be treated. It may well be more productive  to concentrate on the pragmatic arguments for radical change because the present system costs far too much and fails to cover millions of citizens.

Trickle-Down Economics by Gerry O'Shea

by Call To Action on 06/07/17

I invite readers to join me in a modest experiment in theoretical economics.

The manager in a town with a population of 5000 finds that she has a surplus of a million dollars coming to the end of the financial year. She decides to distribute it in whatever way is deemed most likely to generate economic activity that will benefit the whole town.

One senior advisor strongly recommends that she divide the money among the 50 richest and most financially successful local people. This expert was very clear that these rich people, all with life stories indicating a high level of success in fiscal matters, would make the best use of the $20,000 check that each would receive, and this would redound to the advantage of the whole community.

Another advisor had a very different perspective. He counseled that the money should be distributed among the 500 poorest people in the town. He argued that the $2000 that each person in this arrangement would receive would generate far more economic activity locally than the other option. This expert pointed out that by giving the surplus one million to the people struggling at the bottom of the economic ladder she could be certain that most of the money would be spent quickly with nearly all the advantages accruing to local businesses.

You are the judge of the two approaches, the first is aptly called trickle-down and the second can be dubbed trickle-up, but please don't write this off as just an intellectual game. It is really serious and the choices involved are being made every day by Republicans in Washington in favor of option one: give more money to the rich, give them big tax breaks - 650 billion over ten years in the most recent proposal - and somehow everyone will be better off.


by Call To Action on 06/01/17

The title of this article will put many people off - climate change is viewed as involving very complex issues and few people want to hear about disappearing coral reefs or the impact of thawing permafrost on the heating of the planet. It is much easier to espouse an opinion on how to deal with the dictators in Syria or North Korea or to take a stand on that famous wall on the Mexican border.

Most people are engaged with day-to-day issues that impact their lives - taxes, prices in the supermarket and the effectiveness of our educational system. However, in this context we need to consider the longer-term effects of our behavior and the policies that our government pursues. American Indian wisdom urges us to take responsibility for how our actions or inaction affect people's lives "seven generations" from now.

Americans are divided on the reality and seriousness of global warming. More than 95% of climate scientists are clear that we are facing urgent problems caused mostly by carbon emissions in the atmosphere, mainly generated by coal and oil. The rising ocean levels and retreating glaciers are clear warning signs of impending disasters. If our temperatures rise another three degrees Celsius, environmental experts warn that the consequences for our planet will be cataclysmic.

Those who disagree with the overwhelming scientific consensus argue either that the whole climate change crisis culture is a creation of the liberal scientific establishment, or that, while climate change is real, it is no different from unavoidable natural phenomena that have been experienced in previous geological ages.

 These deniers and doubters are now in power in this country and, true to form, they are slashing the funding for agencies and programs that are in place to protect the environment. For instance, Mr. Trump has promised to promote coal-fired power plants that are clearly unhealthy for the air people breathe, while oil pipelines leaking dangerous vapors also have his approval and blessing.

It speaks volumes for the President's attitude to the Environmental Protection Agency(EPA) and to the whole question of climate change that he appointed Scott Pruitt to head the agency. Mr. Pruitt, a former attorney general in Oklahoma, repeatedly challenged the authority of the EPA, the agency he now leads, to regulate mercury levels or smog and carbon emissions. Surely a case of placing the fox in charge of the henhouse.

The new stress on America-first style narrow nationalism which is also to the fore in parts of Europe is not helpful for those arguing for clean energy because this is an international problem. Polluted air and water obviously do not recognize border divisions. The Paris Climate Agreement, negotiated under the aegis of the United Nations in 2015, achieved real progress with 195 governments committing to take action to lower greenhouse gas emissions in their countries.

More people are becoming aware of the dangerous reality of rising sea levels and coastal erosion, and the Paris Agreement was a serious international effort to slow the growth of carbon dioxide in the atmosphere. Mr. Trump and his advisors have talked about pulling out or re-negotiating this important international agreement. Certainly, his negative approach and attitude in this area compare poorly with his predecessor, President Obama's firm commitment to combating policies that damage the ecosystem.

The President uses job creation as his main argument for supporting the development of the coal and oil industries. In fact, the biggest area of sectoral employment growth in the last decade has been in the renewable energy industry. The costs of solar and wind power have dropped significantly in recent years and close to three million new jobs have been created by companies promoting these new clean technologies.

There is also a strong moral dimension to this issue. All the world religions agree that we have a profound solemn obligation to respect all creation and preserve the land, sea and air with their myriad forms of life for future generations.

 Pope Francis in his compelling encyclical, Laudato Si, published two years ago, wrote of global warming causing "severe droughts, floods, fires and extreme weather events - contributing to the heart-rending refugee crisis." He has added an eighth Work of Mercy to the traditional seven, calling it "Care for Our Common Home," and he urged all Catholics to go to confession to seek absolution for their sins against God's creation.

Global warming should not be a political party consideration in the United States. It is not a Democratic or Republican issue; liberals or conservatives cannot claim it as their own. Traditional conservatives and liberals always called for serious consideration for the long-term consequences of government actions, and indeed, a recent poll showed that a slight majority of voters describing themselves as liberal or moderate Republicans support implementation of the Paris Agreement on the environment. President Trump should listen to these voters.


by Call To Action on 05/24/17

Some readers may recall Pete Hamill's articles in the New York Post in the 1970's when that newspaper had real credibility in the tristate area. He wrote about the outrages of his time in strong, direct language. From the carnage in Vietnam to family-destroying poverty at home to the disgraceful plight of nationalists in Northern Ireland, Pete conveyed his deeply-felt disgust and harsh criticism of the status quo. This was not just an intellectual exercise for Hamill because his heart was openly in every paragraph.

I thought of his genuine espousal of the journalism of outrage when I heard the contents of the Republican Bill to repeal the Affordable Care Act (ACA), better known as Obamacare. Their proposal involves removing about 20 million people from the health insurance policies that they now have, and the savings in Medicaid and in the current subsidies for individuals and families, estimated at 600 billion over ten years, will go in tax reductions to the rich - and the more affluent you are the more you benefit. Yes, a majority of Republicans in the House of Representatives passed this bill and then joined the President in the White House to drink champagne to celebrate their sordid success.

The Democrats have condemned the new Bill in the strongest terms and promised to defeat it in the Senate. But where are the church leaders, the moral leaders, where is their outrage? Why have I not heard a sermon about the moral abomination of this legislation? Has nobody read the bible, both Testaments, where abusing the poor is the first cardinal sin?

Paul Ryan, a churchgoing Catholic, led this assault on the poor as Speaker of the House and, shamefully, was a central part of the subsequent celebratory backslapping in the White House. I have not heard any suggestion that he has even received a finger-wagging by any church dignitary or theologian for his leadership in passing this morally repulsive legislation.

The argument that Ryan and others trotted out repeatedly on television is that everybody will have access to any health care policy they want. Of course, nobody ever said that access is the problem because the poor, including millions of workers, can't afford to pay for a policy without government subsidies. Access is obviously not the issue - paying for coverage is.

They also argue that the government should not force young healthy people to have insurance coverage, thus rejecting a central tenet of the ACA. This runs counter to a needed sense of community and solidarity among Americans and neglects the obvious point that today's ebullient youth are tomorrow's vulnerable seniors.

The first moral question in Catholic social teaching for judging any proposed legislation asks: How does this impact the common good? Promoting a culture of selfishness has disastrous consequences in any community and clearly fails the critical "common good" test.

Allowing young people to opt out of coverage is a blatant pander to people's worst instincts. Who pays for the uninsured young person who gets sick? Who foots the bill for the uninsured young woman who discovers she has a latent pre-existing condition? I'm alright Jack and don't look to me to cover the insurance costs of older vulnerable people - unless of course I am in an accident and must rely on the government to pay for my emergency care!

Obamacare has problems that need to be addressed, but the central item in the Republican agenda since the Bill was passed eight years ago has been to repeal and replace it completely. Amazingly, they had eight years to come up with an alternative and the disgraceful Bill that just passed the House is the best they can do!

In arguing against the Affordable Care Act, Republicans repeatedly cite problems in some states where there are issues leading to large increases in the cost of some policies. Indeed, there are issues that need to be dealt with, but it is also a fact that overall insurance prices have increased less under Obamacare than in the years before its introduction.

All other Western countries have universal coverage for their citizens and their costs per capita are significantly less than in the United States. These other countries follow different approaches, some involving private insurance companies and employer-based systems as well as the government-pays-all arrangement. Surely, the United States could design a system that respects the positive aspects of our history of providing medical coverage while mandating that everyone must have a policy.

In an interview a few years before he ran for office, Mr. Trump opined that it is unacceptable that any citizen should be without health care coverage. And, indeed, during questions at a recent press conference with the Australian prime minister, he commended the system in his visitor's country as better than what exists in America.

More people are covered under Obamacare than ever before, but, while that is a big step in the right direction, it too is insufficient. The blatant unfairness of the Republican Bill highlights the need for universal coverage, for a system that ensures proper preventive care for every citizen as well as good professional treatment when a person is ill. That should be seen as a human right and a moral imperative.

ACLU CEO Anthony Romero speaks on preserving our Rights.

by Call To Action on 03/11/17

Contributed by CTA Board Member Paula Acuti

The American Civil Liberties Union (ACLU) is a nonpartisan, non-profit organization whose stated mission is "to defend and preserve the individual rights and liberties guaranteed to every person in this country by the Constitution and laws of the United States.

Union Theological presents ACLU CEO Anthony D. Romero 

who will open a discussion on how to preserve our rights and

freedoms during the current administration. 

The video of the speech can be seen at

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