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Barcelona is one of the world's truly great cities: it has stunning architecture, efficient public transit, and gorgeous beaches.

Add a truly progressive mayor to the list.

One of the most-tweeted photos in Spain these days shows riot police hauling away Ada Colau. The image is from July 2013, when the anti-poverty protester was trying to "occupy" a Barcelona bank that was foreclosing on homes.

The caption added by Twitter users: "Welcome, new mayor."

Colau is the first of the indignados, or angry ones — Spain's Occupy movement — to win office. She narrowly defeated Barcelona Mayor Xavier Trias in local elections Sunday.

Cheers of "Sí se puede!" — "Yes we can!" — went up through the crowd at Colau's campaign headquarters in Barcelona overnight, when vote tallies showed she had won.

"This is a victory of David over Goliath," Colau told supporters, beaming.

For background, the Spanish property bubble's collapse -- and subsequent crisis -- really sucked for everyday Spanish citizens. Imagine the American property crisis, but then imagine the pain of actually not being able to declare bankruptcy, leave your mortgage behind and start a new life. In Spain, your mortgage cannot be discharged in bankruptcy court: you will literally be paying for the house you lost for the rest of your life.

So, calling out bankers for their bad behavior is good politics and good sense.

Two years ago, she testified before parliament at a hearing about Spain's foreclosures crisis. On the panel, Colau spoke right after a representative of Spain's banking industry.

"This man is a criminal and he should be treated like one," she said at the time, her voice shaking with rage.

Lawmakers' jaws dropped. Colau got a reprimand from parliament, but her speech endeared her to millions of Spaniards hurt by layoffs and austerity.

"Our politicians prioritized rescuing Spanish banks, over rescuing Spanish citizens," Colau told NPR in a recent interview, reflecting on that February 2013 parliamentary hearing that catapulted her to fame. Video of her rant went viral on Spanish TV and social media.

Yes, we can? Well, yes, Barcelona did!

Congratulations to Ada!

If anything, I hope this huge progressive accomplishment will be a lesson for American journalists who deride Bernie Sanders as a joke. (And for progressives who must work to elect Bernie within this problematic media environment.)

One of those journalists, Matthew Yglesias of Ezra "explains it all" Klein's Vox Web site, regularly publishes "hot takes" treating Bernie Sanders as nothing more than an Internet sensation.

Sanders's virality doesn't show that he has a chance to win. If anything, it's the opposite. His virality stems, in part, from the fact that he isn't even trying. Most politicians are trying, on some level, for mainstream influence. Even a long-shot candidate like Martin O'Malley really might become the Democratic nominee if Hillary Clinton is struck by lightning or suffers some unforeseen meltdown.

Sanders isn't like that. He's not going to win no matter what, and he knows it. After all, he is an avowed socialist with zero interest in big-dollar fundraising who's not afraid to say he thinks the US should fundamentally transform itself into a different kind of country.

Yes, Matt, it is possible for real progressives to win by calling out banks on their criminal behavior. Ada showed this to be true in Spain -- and Bernie -- announcing his candidacy this afternoon -- will show it to be true in the United States, too.

Imagine being struck with a truly horrible disease -- perhaps hepatitis C -- and there is a cure available. A really good cure. What some might describe as a "miracle" of modern medicine. But, wait for it, then you are told by some faceless bureaucrats at a for-profit health insurer that you are not sick enough for that cure -- first, you must get more sick, suffer more, have your body collapse more before you are eligible for the cure. Imagine the mental anguish. Imagine the mental -- not hyperbole to employ this diction -- torture.

This, my friends, is what West Hollywood resident Shima Andre faces -- this is her life.

Here are the basic facts courtesy of the Los Angeles Times.

A West Hollywood woman sued insurer Anthem Blue Cross for refusing to cover the cost of an expensive drug that she says would cure her hepatitis C infection.

Shima Andre said in the lawsuit that Anthem has refused to pay the estimated $99,000 it would cost to be treated with the controversial drug Harvoni, which has been shown to destroy the deadly virus in most patients.

In a denial letter, Anthem explained that the drug was “not medically necessary” because Andre does not have advanced liver damage, the lawsuit said.

“We may approve Harvoni when the liver has a certain amount of scarring on a liver biopsy,” the insurer explained. “Records we received do not show that your liver has this amount of scarring.”

Andre, 42, who was diagnosed with hepatitis C in 2011, said she was thrilled when the Food and Drug Administration approved the drug last year. But she hasn't been able to take it because Anthem declined to cover the cost. She said she has postponed becoming pregnant because she fears she would pass along the virus to her child.

Yes, imagine being told by an Anthem (formerly known as WellPoint) Blue Cross bureaucrat -- the same insurer that retroactively denied cancer care to breast cancer patients (a practice so barbaric that President Obama called them out by name) -- that your liver simply does not have a sufficient "amount of scarring" to qualify for coverage of the drug that would change your entire life. In the case of Ms. Andre, being cured from the disease would also allow her to become pregnant.
Andre, 42, who was diagnosed with hepatitis C in 2011, said she was thrilled when the Food and Drug Administration approved the drug last year. But she hasn't been able to take it because Anthem declined to cover the cost. She said she has postponed becoming pregnant because she fears she would pass along the virus to her child.
Ms. Andre's story brings tears to my eye. Anthem Blue Cross is not only denying her the chance to live a normal, healthy life, but also the chance to have a normal, healthy baby -- without fear of the baby contracting a terrible disease.

Yes, my friends, this drug -- Harvoni -- is good. This is not a case of a drug that may or may not work. Look at the record.

Harvoni is a pill taken once a day for eight to 12 weeks that has been proved in clinical testing to wipe out the virus in more than 90% of patients, without significant side effects.
Of course, however, because the drug is so amazing, it is also expensive. Really expensive. Curing Ms. Andre would cost about $99,000 and, as a big-profit corporate insurer, Anthem has shareholders to please.

Let's unpack this Anthem abuse below the fold.

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On November 4, 2008, President Barack Obama proclaimed the following in his election night victory speech:

"This is our time, to put our people back to work and open doors of opportunity for our kids; to restore prosperity and promote the cause of peace; to reclaim the American dream and reaffirm that fundamental truth, that, out of many, we are one; that while we breathe, we hope. And where we are met with cynicism and doubts and those who tell us that we can't, we will respond with that timeless creed that sums up the spirit of a people: Yes, we can."
The problem, though, is that President Obama was misreading recent history. America is not the country of "yes, we can."

No, we can't build a Metro line to connect rich and poor neighborhoods in our nation's capital.

No, we can't rebuild ancient tunnels connecting the wealthiest city in the wealthiest country on Earth to the other side of a river.

No, we can't ensure that every man, woman and child can see a doctor when they get sick.

No, we can't provide women with the chance to spend some time with the miracle -- miracles, if twins -- they just brought into the world. (And, no, we can't do it for dads, either.)

No, we can't keep our kids safe when they show up at school, because it's too fucking hard.

No, we can't let our middle- and working-class kids study for free.

No, we can't protect our (huge number of) prisoners from rape.

No, we can't do our part as a nation to combat global climate change.

No, we can't even win our wars of choice

For a nation that prides itself on reinvention, renewal and optimism, it's particularly sobering to consider not what we can do in America, but what we can't do.

America is not just a country with gross political dysfunction and corruption -- remember, even Italy (i.e. a collection of medieval city-states that wasn't a country until 1861) has been able to "do" high-speed rail, maternity leave and outstanding socialized health care -- it is a country where there is no longer even a consensus amongst Very Serious Elites that the "state" -- classically-defined -- should serve any purpose at all, perhaps beyond protection of property and global capital. Both of those roles, however, are to be understood in the negative: no, you can't rob me. No, you, foreign leader in the "Axis of Evil," can't defy our wishes.

This is a huge problem -- a cultural, social, historical problem that won't be solvable with our weak institutions and insane politics.

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The United States is the 33rd best place in the world to be a mother, according to the 2015 State of the World's Mothers report prepared by Save the Children. And, adding insult to injury, 33rd is actually two spots lower than last year's ranking. We are literally standing by as mothers die. This is not benign neglect -- it is malignant neglect.

Women in the United States face a 1 in 1,800 risk of maternal death, the worst odds of any developed country in the world, according to the report.
At 33rd, the U.S. ranks behind Croatia (30), Poland (28), Belarus (25), Portugal (16) and Italy (12). For some context, the monthly minimum wage in Portugal is less than 600 euros a month.
The top 10 best countries to be a mother are almost all European countries (from 1st to 10th): Norway, Finland, Iceland, Denmark, Sweden, Netherlands, Spain, Germany, Australia and Belgium.
That the U.S. is a tough place to be a mother should not be surprising to anyone. Just look at how our nation's capital compares to other capital cities in the rich world.
Among 25 of the wealthiest capital cities surveyed around the world, Washington, D.C. has the highest infant mortality rate. The study also found that babies from the District’s poorest wards are dying at much higher rates than the city’s already high average.
And, just 30 minutes from the nation's capital in Baltimore, two neighborhoods have higher infant mortality rates than the West Bank.
But there are two neighborhoods in Baltimore — Little Italy and Greenmount East — with infant mortality rates above 20. This means that for every 100 babies born there in 2013, two died before their first birthday. That's a higher rate than you find in the West Bank, Honduras, or Venezuela.
We should be ashamed.

He "earns" compensation that would make a Russian oligarch jealous.

UnitedHealthcare CEO Stephen Hemsley took home over $66 million in 2014.

CEO Pay Watch UnitedHealth Group Inc.

Stephen Hemsley, CEO

Total compensation: $66,125,208 for the year ended Dec. 31, 2014

Salary: $1,300,000

Non-equity incentive pay: $3,949,000

Other compensation: $107,479

Exercised stock options: $45,569,049

Value realized on vesting shares: $15,199,680

New stock options: 83,918

Yes, times are good for Mr. Hemsley, who actually "earned" an even more eyewatering $102 million in 2010.
The top earner in our report was UnitedHealth Group chief Stephen J. Hemsley, with $102 million in total pay. Hemsley drew $3.3 million in salary and bonus, but also realized $98 million from the exercise of vested stock options.
Yes, leading a health insurance company is probably "hard." But is it harder than being President of the United States? Doing brain surgery? Or, well, even working as a waitress? Or selling newspapers for cash donations on the cold streets of DC while homeless?

Probably not.

And yet, even as our health care "system" and present political economy facilitates this grotesque profiteering by Mr. Hemsley, regular Americans continue to lack access to medical care for inability to pay.

A new study finds that significant numbers of people have less money available in liquid assets than what they face in the maximum deductibles and total out-of-pocket health cost limits under insurance plans.

Only three in five households have enough liquid assets to meet a deductible of either $1,200 per individual or $2,400 per family, according to the Kaiser Family Foundation study. Only about half of U.S. households had enough such assets to cover higher deductibles of $2,500 per individual or $5,500 per family.

The situation only gets worse for households when considering their exposure to total out-of-pocket costs. Just 48 percent of households have enough liquid assets to cover what were considered to be the mid-range of such out-of-pocket health cost limits: $3,000 per individual and $6,000 per family, according to the Kaiser study.

Just 37 percent can meet the higher range of such costs, or $6,000 per individual and $12,000 per family, the study found.

In other words, the same deductibles, co-pays and cost-sharing tools that force patients to "put more skin in the game" simultaneously take some of UnitedHealthcare's "skin out of the game." As patients choose between paying the rent or taking their feverish child to the emergency room, delaying cancer care or buying milk, Mr. Hemsley -- and his other parasitic friends leading America's truly "exceptional" for-profit health insurers -- gets richer and richer as UnitedHealthcare's exposure to the absurd cost of American health care declines.

Yes, some folks are directly impacted from this greed: they will never seek care -- or delay care -- and die. Still, when sick people delay or deny themselves care -- or have bureaucrats at Mr. Hemsley's firm do it for them -- we all suffer. Our economy suffers, productivity suffers, public health suffers, our nation is a weaker place.

According to the Social Progress Index -- a kind of "GDP for human wellbeing" with updated data released yesterday for 2015 -- the United States is doing really, really bad in the area of nutrition and basic medical care. The Greatest Nation on God's Earth ranks...41st!

Finland ranks first -- and, well, we rank below Slovenia, Italy, Spain, Cyprus, Estonia, Denmark, Ireland, Croatia, Greece, Israel, Poland, Belarus, Montenegro, the United Kingdom, Macedonia, Portugal, Bosnia, Serbia, Slovakia...and, as you can see, that's just a "selected few" of the countries achieving better outcomes in health.

Yes, Mr. Hemsley's salary is part of the problem. This is why we could not even achieve a public option, let alone a single-payer system. Mr. Hemsley is a powerful oligarch -- and he won't give up this kind of wealth without a fight.

Oh, and, Mr. Hemsley's social media folks are kind enough to offer a tip on saving money for a "rainy day" (errr...paying a massive UnitedHealthcare deductible or co-pay):

Brutal, ain't it?


Damn, the "Rolls Royce isn't moving fast enough."

This is how Jim Edwards, an American-British dual citizen, characterizes actually having to wait to be seen by a highly-trained medical professional in his outstanding first-person account of NHS treatment.

The context here is that the NHS just released its most recent stats on accident and emergency room waiting times. The headline number is that 84% of patients are seen within four hours. In the UK, this is regarded as a huge failure — the standard the NHS is supposed to meet is 95% of patients in four hours. The UK media went into a fury about it, and some hospitals have begun postponing and rescheduling some non-emergency procedures in order to get those waiting times down.

In the US, having sat in many an ER waiting room for hours at a stretch, the idea of a hospital seeing nearly 9 out of 10 patients in four hours would be regarded as a miracle. Bear in mind that within that four-hour period the NHS doctors are triaging patients: If you get hit by a bus, you're going to see someone instantly. If you broke a finger because you fell over while drunk at the pub, you're probably going to wait at the back of the line. It's not like people are literally bleeding to death while they wait for attention (although the British media loves it when it finds individual cases where that has happened).

So my overall impression is that currently, the Brits' complaints that the NHS isn't hitting that 95% mark is akin to saying, "This Rolls Royce isn't moving fast enough!"

Amen, Brother.

This article is worth reading carefully and in full, because it perfectly frames the greatest weakness of the American approach to health care: there is no system; literally we have a non-system of health care. Nothing is coordinated; the all-mighty $ is the only unifying logic to our so-called "system."

Because there is an actual system, patients experience significantly less aggravation with accessing health care. Paperwork?

There is a load of paperwork for patients in the US. This is easily the worst aspect of US healthcare — the billing paperwork. If you've ever had any health issue that required more than a simple doctor visit, you will know that it precipitates a seemingly never-ending series of forms, bills, and letters. You can be paying bills months, years later. And it's almost impossible to correct a billing error. It's stressful. I developed an intense hatred for health insurance companies in the US because of this.

There was close to zero paperwork in the NHS. I filled in a form telling my doc who I was and where I lived, and that was pretty much it. The only other paperwork I got was a letter in the mail reminding me of my next appointment. They sent me a text reminder, too, which no American doc has ever done. It was incredibly refreshing.

But, wait, the absence of insurance forms must -- in some bizarre way -- make UK doctors of lower quality. Well, not really.
The treatment from my primary care GP was the same in the UK as it was in the US. I've had great care from 95% of doctors I've ever seen in both the US and the UK. Doctors are doctors. They're mostly really nice and good at what they do. The system that pays them doesn't seem to make them better or worse.
I won't reproduce the entire story here, because I want you to read it, but I will end with a reminder that this patient -- who underwent specialist treatment at a hospital for fear he was going deaf -- paid ZERO at point-of-use for his care. (Yes, of course, he paid payroll tax, but he probably paid much less than you pay in Medicare tax and premiums and cost-sharing and co-pays and deductibles and time wasted filling out forms and time wasted waiting for inefficient medical practices to see patients.)
So how much did all this NHS care cost me? £0. Nothing. Zero. I paid not a penny for some top-notch healthcare. There is no such thing as a "free," of course, but the per-capita cost of healthcare in the UK (paid by the government via tax collections) is generally lower than the US, according to the World Health Organization. Americans spend $8,362  per capita on healthcare annually, the Brits spend $3,480. Here is a breakdown:

NHS prices

Doctor visit: £0
Specialist: £0
Diagnostic test: £0
MRI: £0
Total: £0
Typical US prices*

Doctor visit: $100
Specialist: $150
Hearing test: $72
MRI: $1,000
Total: $1,372 (Total payable by the patient in cash, or typically 90% from insurance and 10% as a patient copay. Prices taken from Healthcare Bluebook.)

To me, those US prices seem pretty low -- and remember, if Jim was uninsured in the US, he'd pay whatever the hell the hospital wanted to charge him for each of those things. You know, "chargemaster" and all.

Jim's final verdict? US or UK?

The bottom line: I prefer the NHS to the American private system. It's a little more inconvenient in terms of appointment times, but due to the fact that it is free, has no paperwork, and the treatment on the day is super-fast, the NHS wins. That Rolls Royce is moving at a pretty decent clip.

And, of course, there is the small matter of the fact that the NHS covers everyone equally, whereas Americans get care based on their ability to pay, leaving tens of millions with only minimal access to care. (Obamacare is changing that, but it's leagues behind the NHS if you're comparing them by the standard of universal full-service coverage.)

Americans think they have the best healthcare in the world. Take it from me, a fellow American: They don't.

As a dual American-European citizen myself, who has accessed the UK NHS on several occasions while living in London, I would completely agree with Jim. And it's really not just about the money (although it feels great to know that a single trip the ER won't rob you of $1,000) -- as this narrative points out. It's also about the forms, the frustration and wasted time. Over a lifetime of dealing with Aetna or Cigna and profit-driven hospital billing departments, how much time do you waste on the 1-800 number? How much of that time could you be spending drinking a beer? Talking to a loved one? Taking a nap? Walking in the park?

The American health care non-system is a disaster -- this article is a good reminder of how a decent society handles things in a more civilized way. Please share widely.


Probably known more for its presence in the lobby of the Econolodge or Holiday Inn than exhaustive, in-depth reporting, USA Today has hit it out of the park with its recent article on the crushing burden -- for an increasingly-strapped middle class -- of health care in America.

Americans -- working full-time jobs in the formal economy -- are simply being abused by this country's bloated medical-industrial complex. Let's start with a heartbreaking anecdote and then dig deeper.

Jennifer Ross, an arthritis sufferer in Florida insured through her husband's job, says she recently made the wrenching decision not to take a medication that might allow her to get around without her wheelchair. The $2,400-a-month medicine would cost her $600 a month out-of-pocket even with insurance, and she simply can't swing it. To make matters worse, Ross' 12-year-old daughter was recently diagnosed with arthritis, too.
Reread the aforementioned and join me below the fold.
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Aetna is being sued by Consumer Watchdog, a California advocacy group, for discriminating -- likely in pursuit of lower costs and more profits for Wall Street shareholders -- against HIV patients.

A consumer group has sued the health insurer Aetna, claiming that it discriminated against patients with H.I.V. when it required them to obtain medications exclusively through its own mail-order pharmacy.

The lawsuit, filed Friday in federal court in San Diego by the advocacy group Consumer Watchdog, argues that Aetna’s policy violates the new federal health care law, which prohibits insurers from discriminating against people based on medical condition.

The company’s new policy, which takes effect Jan. 1 and applies to people who have purchased individual coverage, also raises the out-of-pocket amount that patients must pay for their treatments, potentially doubling it in some cases, according to the suit.

Mandating mail-order pharmacy use can be incredibly problematic for those individuals -- the poor -- without a reliable address or for those who wish to keep their condition private from roommates or neighbors. (But, for Aetna, requiring the use of its own mail-order pharmacy means more profits for the multi-billion dollar corporation whose CEO earns about $90,000 a day according to Physicians for a National Health Program.)
The [federal Health and Human Services] department said that requiring consumers to use mail-order pharmacies could discriminate against people without a fixed address, or those who wished to keep their conditions confidential from neighbors or co-workers who might see the packages. The department has not said whether it will go forward with the proposed rule.

Insurers and pharmacy-benefit managers for years have been prodding consumers with chronic medical conditions to obtain their drugs through mail-order pharmacies.

Besides serving as an added revenue stream, mail-order pharmacies keep down costs as well as premiums, the industry claims. Compared to a neighborhood pharmacy, specialty mail-order pharmacies can also keep better track of the needs of patients with serious medical conditions, the industry says.

Worse, however, than Aetna profiting from inconveniencing HIV patients is the fact that mandating mail-order pharmacy use can, obviously, endanger the health of patients when drugs are inevitably delayed or "lost in the mail." This is particularly dangerous for HIV patients.
But patient advocates say that the restriction of patients to mail-order programs has been particularly onerous for people with H.I.V. Often, they have close relationships with local pharmacists, some of whom specialize in treating people with the virus and are aware of the long list of additional medications that many patients must take.

Refilling medications through the mail breaks that bond, advocates say, and also increases the risk that patients will miss a dose if a refill is not delivered on time. Missing even a small number of doses can lead to a resurgence of the virus.

So, to be clear, Aetna -- and other insurers accused of discrimination in the past -- are certainly aware that missing a dose of an important drug can lead to resurgence of the virus, but they still insist that patients use mailorder pharmacies -- just to send a few more bucks to their shareholders.

But, wait, there's more. Aetna has also -- it appears -- switched HIV patients from paying a co-pay to co-insurance -- leading to dramatically-increased out-of-pocket costs for their drugs.

But the lawsuit asserts that the new policy raises the out-of-pocket costs of the drugs. Previously, Aetna members had to pay $20 to $70 per prescription for H.I.V. drugs. Now they will be asked to pay 20 percent of the cost of the drug, up to $150, the lawsuit said.
Insurers in other states have also been blasted for discriminating against HIV patients, including an Aetna-owned subsidiary (Coventry) in Florida.
Two groups, the AIDS Institute and the National Health Law Program, filed a complaint on Thursday with the Department of Health and Human Services’ Office for Civil Rights, saying the insurers had violated a provision in the new health care law that prohibits discriminating against consumers because of their medical conditions. They said the insurers had subjected people infected with H.I.V. to restrictions on medications that most patients take daily to keep the virus in check.

“This practice has no rational reason other than to drive people with H.I.V. and AIDS away from their plans,” Wayne Turner, a staff lawyer with the National Health Law Program, said in a conference call with reporters.

The complaint asserts that the four insurers — CoventryOne, Cigna, Humana and Preferred Medical Plan — placed H.I.V. drugs on the highest payment tier for midlevel, or silver, plans on the federal health insurance exchange in Florida.

This discrimination against HIV patients is a uniquely-American perversion of socially-just health care delivery.

In countries like England, France, and Italy -- ones with highly-regulated, government health care systems -- those who face the worst medical problems -- diabetes, HIV, AIDS, Cancer -- actually pay the least for health care. For example, while healthy patients pay minimal co-pays for drugs in England and Italy, those with cancer, HIV or diabetes pay nothing -- ZERO -- for drugs. You know, operating under the assumption that getting really, really sick for a really long time is problematic enough.

We could have that solidarity principle, too, but only if we fire the big-profit insurers -- like Aetna -- and replace them with single-payer, Medicare-for-all.


While we're "debating" torture, access to basic health care and the veracity of climate change, the rest-of-the-world is simply advancing transformational infrastructure like you would not believe.

In Switzerland, the world's longest rail tunnel -- straight through the Alps -- is about to open.

At 57 kilometres, the Gotthard Base Tunnel, which will travel through the Alps between the northern portal of Erstfeld and Bodio in the south, will become the longest rail tunnel in the world once complete, stripping the title from Japan’s 53.85 kilometre Seikan Tunnel.
Meanwhile, the ancient tunnels between New York City and New Jersey -- dating from 1910 and about 4,400 meters long -- are so old -- and damaged from recent hurricanes -- that they risk forced closure -- and economic catastrophe for America's largest city -- at any time.
Losing one of the current tunnels would be a commuting nightmare, but getting financial support for Gateway will be be difficult, said Len Resto, New Jersey Association of Railroad Passengers president.

"The situation gets more dire day by day," Resto said. "You will get delays unacceptable to the riding public and it will become an economic factor. There's only so much that employers will put up with if people can't get to work on time."

Italy now boasts Europe's fastest high-speed train -- capable of speeds up to 400 km/h (249 mph) --  that will cut travel times between Rome and Milan -- about the distance between Washington, D.C. and Providence -- to two hours and some change.
The high-speed electric-multiple unit (EMU), which is expected to be put into service on the Rome-Milan corridor by Trenitalia in 2015, is certified for speeds up to 360 km/h but is capable of 400 km/h running.
(And it's not just the sexy Italians who are leaving us in the infrastructure dust. As George W. Bush wouldn't want me to do: don't forget Poland!)

Meanwhile, Amtrak still has no concrete plan -- and no government support -- to bring true high-speed rail to our most densely-populated, north-south corridor. Our "high-speed" Acela train runs slower than most "regional" trains in Europe and Asia.

On a 30-mile stretch of railroad between Westerly and Cranston, R.I., Amtrak’s 150-m.p.h. Acela hits its top speed — for five or 10 minutes. On the crowded New York to Washington corridor, the Acela averages only 80 m.p.h., and a plan to bring it up to the speed of Japanese bullet-trains, which can top 220 m.p.h., will take $150 billion and 26 years, if it ever happens.

Florida, Ohio and Wisconsin, all led by Republican governors, canceled high-speed rail projects and returned federal funds after deeming the projects too expensive and unnecessary.

Even as Americans are stuck traveling on the MegaBus, China has agreed to finance construction of a new high-speed line -- through the formerly war-torn Balkan states -- from Belgrade to Budapest -- by 2017.
China has signed an agreement with the governments of Serbia, Hungary and Macedonia for the construction of a new high-speed railway between Belgrade and Budapest.

Speaking after the signing ceremony, Chinese Premier Li Keqiang said the railway would be complete within the next two years. Feasibility studies are expected to to be carried out by June next year and the project completed by June 2017.

The new 200km/h line will reduce travel times from eight to around two-and-a-half hours between the two capital cities.

And that small high-speed line in the Balkans is just the tip of the exciting infrastructure plans China -- in collaboration with Russia and the European Union -- has for connecting Eurasia -- constructing a new "silk road" for the 21st Century. Look at what just arrived in Spain.
The longest rail link in the world and the first direct link between China and Spain is up and running after a train from Yiwu in coastal China completed its maiden journey of 8,111 miles to Madrid.

En route it passed through Kazakhstan, Russia, Belarus, Poland, Germany and France before arriving at the Abroñigal freight terminal in Madrid.

The railway has been dubbed the “21st-century Silk Road” by Li Qiang, the governor of Zhejiang province, where Yiwu is located. Its route is longer than the Trans-Siberian railway and the Orient Express.

The first train was met by the mayor of Madrid, Ana Botella, and Spain’s minister of public works, Ana Pastor. It consisted of 30 containers carrying 1,400 tonnes of cargo – mostly toys, stationery and other items for sale over Christmas across Europe.

According to China’s ambassador to Spain, Zhu Banzao, it will return laden with wine, jamón and olive oil in time for the Chinese new year in February.

Meanwhile, outside Eurasia, Brazil -- the second-largest economy in the Americas -- is choosing to bypass the United States -- and its tech companies -- in laying the groundwork for its high-tech future.
There's a new wrinkle in Brazil's plan to build a $185 million undersea fiber-optic cable that would connect it to Portugal and help the country avoid surveillance by U.S. intelligence authorities, reports Bloomberg: The cable will be built without the help of any U.S. companies.

While Brazil arguably led the world's outrage over the Edward Snowden disclosures, its ire has mellowed a bit in recent months. But that Brazilian authorities are still talking about a U.S.-free undersea link to Europe only underscores something that may be especially destructive to U.S. tech companies: Once you write foreign policy into fiber-optic cables, it stays that way for a long, long time.

These developments aren't just cool -- as in fast trains and long distances -- but they herald the end of American economic dominance; they are concrete symbols of our relative decline versus the other great nations -- and regions -- of the world.
All these interlocked developments suggest a geopolitical tectonic shift in Eurasia that the American media simply hasn't begun to grasp. Which doesn't mean that no one notices anything. You can smell the incipient panic in the air in the Washington establishment. The Council on Foreign Relations is already publishing laments about the possibility that the former sole superpower's exceptionalist moment is "unraveling." The US-China Economic and Security Review Commission can only blame the Chinese leadership for being "disloyal," adverse to "reform," and an enemy of the "liberalization" of their own economy.

The usual suspects carp that upstart China is upsetting the "international order," will doom "peace and prosperity" in Asia for all eternity, and may be creating a "new kind of Cold War" in the region. From Washington's perspective, a rising China, of course, remains the major "threat" in Asia, if not the world, even as the Pentagon spends gigantic sums to keep its sprawling global empire of bases intact. Those Washington-based stories about the new China threat in the Pacific and Southeast Asia, however, never mention that China remains encircled by US bases, while lacking a base of its own outside its territory.

Yes, the rest-of-the-world has problems -- many of which are worse than our own: horrid unemployment in Italy, extreme gun violence in Brazil, horrific absolute poverty in China -- but, and this is crucial, even as they grapple with these challenges, they are still investing in the future -- in long-lasting ways. And, worst of all from the perspective of the United States, they are doing so to the exclusion of our nation: leaving behind our companies, our people, any concern for our relevance.

The United States is being left behind. We will -- absent major change -- never be able to catch up with the infrastructure of Asia and Europe, given current political conditions in this country. And the most tragic part of this decline is that it's being actively promoted by our leaders.

The clock is ticking. The rest-of-the-world is not waiting while the United States "debates" the future. It is building the future.


I'm just going to be blunt: if the US were to impose Obamacare -- as a universal health care solution -- on any other rich country, the citizens would surely revolt: cars would be burned, Parisian cafe tables would be thrown threw windows, Italian espresso machines would be turned into bombs. Well, you get the idea.

Two recent articles from the New York Times and Yahoo News highlight two structural problems with no solution in sight: patients delaying needed care because of massive deductibles and patients being left with crippling, foreclosure-inducing debts because they can't afford to pay their bills -- particularly to out-of-network providers excluded from new narrow-network plans -- after undergoing major treatments.

Deductibles for Obamacare plans are high, really high. In a nation where the majority of the population -- over 75 percent -- is living paycheck-to-paycheck, there is little left over for a $1,000 deductible, let alone the $4,000 or $5,000 deductibles common with the cheapest Obamacare plans. (And, remember, once you hit the deductible, you still have cost-sharing.)

Deductibles for the most popular health plans sold through the new marketplaces are higher than those commonly found in employer-sponsored health plans, according to Margaret A. Nowak, the research director of Breakaway Policy Strategies, a health care consulting company. A survey by the Kaiser Family Foundation found that the average deductible for individual coverage in employer-sponsored plans was $1,217 this year.

In comparison, the average deductible for a bronze plan on the exchange — the least expensive coverage — was $5,081 for an individual and $10,386 for a family, according to HealthPocket, a consulting firm. Silver plans, which were the most popular option this year, had average deductibles of $2,907 for an individual and $6,078 for a family.

With deductibles this big, patients avoid seeking care in the same way as the uninsured.
But insurance plans with lower premiums generally have higher deductibles. Gina Brown, 37, of Nashville, was paying about $155 a month for a Blue Cross Blue Shield of Tennessee plan, after taking account of her subsidy. But her deductible was $4,000, she said, and so she avoided going to the doctor even when she got an ear infection over the summer.

“I attempted to treat it with over-the-counter and homeopathic meds,” she said. “Eventually it went away.”

But, what if it didn't go away? Or what if the ear infection was symptomatic of a much larger medical problem requiring complex care? A problem that could have ballooned out of control as Ms. Brown played around with "homeopathic meds"?

Sometimes, though, the massive deductible is the least of a patient's worries, because the plan with a massive deductible also comes with a narrow network of doctors that punishes Americans living in rural areas or plagued with uncommon diseases.

Dr. Rebecca Love, of Moab, Utah, is well on her way to passing that limit. Dr. Love, 63, who has degenerative arthritis and a host of other health problems, pays $422 a month in premiums for a plan that has a deductible of $6,000. But she has already paid more than $6,000 in medical costs this year that did not count toward her deductible because the doctors and hospitals — more than 100 miles away in Grand Junction, Colo. — were not in her network.

To see certain specialists in her network, Dr. Love said, she would have had to travel to Salt Lake City, which is much farther away and requires driving through a treacherous mountain pass.

“Medical care costs too much and health insurance as it stands doesn’t address this,” she said. “What have we become?”

Republicans attack Obamacare as "redistributing wealth," but the reality is that Obamacare actually does very little redistribution. Think about it this way: in England or Italy or France, the poor and struggling -- or those stuck with chronic diseases like diabetes -- pay absolutely zero for health care -- kind of like Medicaid -- and have the most financial protection. In the US, however, those just above the cut-off for Medicaid and stuck with Obamacare junk insurance instead of Medicaid (and, don't believe the horror stories, Medicaid is actually more popular than Obamacare private insurance), face tremendous financial uncertainty. The executives of Goldman Sachs -- with their gold-plated insurance plans subsidized by the "average Joe" American taxpayer -- enjoy more financial protection from medical costs under their plans even though they have the capacity to pay just about any medical bill sent their way. A universal health care "system" that operates in this way is hardly facilitating redistribution.

So, just what happens when those plagued by junk insurance face crippling medical costs that their "Blue Cross HSA 4,000" plan fails to adequately cover? Well, even the most prosperous families quickly spiral downwards into the ranks of the truly poor.

In their 30 years of marriage, the Overvolds had each taken on traditional household duties — Lee worked and managed the finances, while she cared for their two sons at home.  At the time of his diagnosis, Lee earned $120,000 a year working in sales for an energy company in their hometown, Fontana, Calif. The rigor of his treatment regimen forced him to leave his job on disability, which cut the family’s income by 40%. Very quickly, his hospital bills consumed their emergency savings and the couple began drawing on his retirement benefits much earlier than expected.

“At least five of his cancer specialists weren’t covered by our insurance,” Deanne says. “And one day the hospital would charge $300 for one drug and the next day it would cost $750. It’s like it just keeps coming and you can’t stop it.”

Lee died in August, less than six months after his diagnosis. Deanne was left with more than $100,000 in hospital and physicians’ bills, she estimates -- an amount far too inadequate for her savings to cover. Six years away from reaching full retirement age herself, she’s begun looking for full-time work for the first time in more than two decades. On the recommendation of a friend, she enlisted the help of a financial advisor who specializes in helping widows and widowers.

“We had planned to retire at 67 and we had everything planned out,” Deanne says. “Now, there is no plan.”

And, let's not forget, that while Obamacare regulates deductibles, it also allows deductibles to rise over time. Obamacare plans will offer less, not more, protection from financial destruction as the years progress. This wouldn't be a problem if wages were increasing for the average worker, but they're not -- people are earning less as insurance offers less protection and already appalling health care prices -- by international standards -- continue to increase.
A report by financial education website released today shines new light on medical debt’s crippling effect on American households. Between 2010 and 2013, American households lost $2,300 in median income, but their healthcare expenses rose by $1,814, according to Nerdwallet. Out-of-pocket healthcare costs are expected to accelerate to a 5.5% annual growth rate by 2023 – more than twice as fast as the national economy, which grew by 1.9% last year.

“We found that one in three dollars that are currently in debt collections are actually medical, which we found quite shocking,” says Christina LaMontagne, general manager of NerdWallet Health and author of the report.

So, this happens, over and over and over again.
Kathy Penton, 58, was the breadwinner in her family when she was diagnosed with Fibromyalgia, a syndrome that causes chronic nerve and joint pain, in 2002. She was in her early 40s, a time when both men and women should be reaching their peak earning years. Instead, the constant pain drove her to leave her management position at the telecommunications company she had worked at for more than 10 years.

Kathy and her husband, Lonnie, 63, who live in Savannah, Ga. went from a dual-income household to relying solely on Lonny’s $50,000-a-year job at an auto repair shop. It took more than two years for Penton to successfully qualify for disability benefits, and by that time the couple had been regularly dipping into her 401(k) account and using credit to make ends meet.

“I know I could have planned better but before I even had a chance think about it, it was gone,” she says.

After paying taxes on early 401(k) withdrawals and sustaining a painful 25% loss during the 2008 financial crisis, Penton says her $100,000 nest egg is practically nonexistent today. When their bank threatened to foreclose on their home after two missed mortgage payments in 2008, it was a major tipping point. More than $20,000 in credit debt, the couple decided to file for bankruptcy.

Progressives may hopefully describe Obamacare as a "starter home" and dream of a natural evolution to single-payer over decades, but such thinking is most certainly unrealistic given the dysfunctional nature of American politics. Even if progressive states like Vermont succeed at implementing single-payer, hundreds of millions of Americans in more conservative states will remain vulnerable to tremendous financial distress as they attempt to access health care.

We are collectively, as a nation, still in a state of health care crisis that would be absolutely unacceptable in any other rich nation.

Americans should probably start hurling cafe tables sooner rather than later.

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Welcome to health care for the rural poor in Virginia, the state just to the south of the capital of the Greatest Nation on God's Green Earth.

It looks like this:

“I just had an 18-year-old have a full mouth extraction because she’s never had dental care,” said Beth Bortz, who runs the Virginia Center for Health Innovation. “It’s not unusual.”

She said patients often want their good teeth removed, too, because they associate teeth with pain. She said health-care providers counsel them to keep them.

And it looks like this:
Every year, hundreds of people have every one of their teeth pulled there. Then they put their names into a denture lottery, with the hope of being picked to get a set of false teeth made for them at the next year’s event. Forty-six people were picked from a list of 700 to get dentures this year.

“They pull thousands of teeth here. At the end, they’ll have buckets of teeth,” said volunteer Jennifer Lee, Virginia’s deputy secretary of health and human resources and an emergency room doctor.

And, well, it looks like this:
In a tent where people waited for a vision exam, McAuliffe knelt beside Martha Deel, whose only job is caring for her brain-injured son. Fifty-one years old, she looked decades older. After her exam, she said she would line up to see a doctor for “the girl stuff.
No, we're not talking Gaza, or Bangladesh, or rural India, or highland Guatemala, we're talking Virginia -- one of our country's wealthiest states full of highly-profitable defense corporations, like Northrop Gunman, whose share price just rose to $123.87/share -- just in case you were wondering. Killing people is big business in Virginia, but apparently saving the lives -- and dignity...and teeth -- of those who live in this exceptional state that likes to call itself a "Commonwealth" is just not worth the money.

Virginia's Democratic governor has been -- in an effort worthy of praise -- heroically trying to expand Medicaid against the insane obstructionism of Republicans in his state's legislature, and on Friday he visited his citizens -- receiving health care in a horse barn -- as a reminder of just how great the stakes are in this fight.

Gov. Terry McAuliffe renewed his pitch for expanding health care to the poor Friday by touring a field hospital set up at a county fairgrounds, where people had camped out for days for the chance to see a dentist or doctor.
McAuliffe flew to the Remote Area Medical expedition in far southwest Virginia, where the line for free dental and medical care was 1,500 long by 4 a.m. Friday, when organizers started turning people away.
“That just breaks your heart,” said McAuliffe (D), standing in a horse barn that served as a makeshift doctor’s office, with bedsheets strung up between examination tables to provide a measure of privacy.
As some of you might be aware, Remote Area Medical was originally founded by a British philanthropist to provide health care to people in places like sub-Saharan Africa and the Amazon.

Here's what the founder, Stan Brock, says inspired its creation:

My vision for Remote Area Medical® developed when I suffered a personal injury while living among the Wapishana Indians in Guyana, South America. I was isolated from medical care, which was about a 26 day journey away. I witnessed the near devastation of whole tribes by what would have been simple or minor illnesses to more advanced cultures. When I left Guyana, I vowed to find a way to deliver basic medical aid to people in the world’s inaccessible regions. So, in 1985 I established the non-profit, Remote Area Medical® or as most people know us - RAM®. RAM® is the way I have kept that promise, not only to the Wapishana Indians, but to thousands around the world in similar conditions. In other words, there are Wapishanas everywhere.
Apparently, Americans are Wapishanas, too.

Single-payer -- independent of employment and cruel state governments -- anyone?

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The same transnational, big-profit health insurance corporation that killed Nataline Sarkisyan is at it again: this time denying a young Georgia girl, Nicole, the ability to hear.

Yes, yes, yes: I know you're probably tired of petitions, but when health insurance nightmares like the ones perpetuated on a daily basis by Cigna strike, parents truly have nowhere else to turn than the Internet. In the United States, medically-necessary health care is sometimes only delivered when mega-corporations have been sufficiently embarrassed in the public sphere. So, first, please do sign and share this petition. (Even if you disagree with and its policies, the reality is that big numbers here do awaken the mainstream media from its slumber.)

Let's look at Nicole's case through the words of her father:

My daughter Nicole was born with several health issues. In her first four months of life she had three bowel surgeries, one heart surgery, bacterial meningitis, and we learned that she would need a liver transplant. We also learned that Nikki suffered from undetermined hearing loss, however during that time the doctors and her family was focused on life saving procedures. Nikki is now three years old (almost 4) and she has neuropathy in her left ear and has been pronounced profound deaf in her right ear.

We have been fortunate to be able to send Nikki to the Atlanta Speech School, which has worked wonders with her speech ability. However, her speech pathologist, therapist, teachers, and doctor have determined that Nikki has reached a plateau and will not likely improve in her speech or hearing abilities. Based on her doctor recommendation along with the advisors at the speech school, we requested Cigna (my employer provided insurance) to cover the cost of the cochlear implant. Cigna denied to cover the implant based on information provided and we appealed.

The initial reason Cigna denied coverage was stated that Nikki’s hearing loss was not significant enough and she had not utilized hearing aids for at least a three-month period. During the appeal Cigna was informed that Nikki had in fact utilized hearing aids in both ears for more than two years, and her deafness was far greater than what Cigna required. Cigna denied our appeal for coverage stating that they felt that Nikki was progressing or could progress with further use of hearing aids. Due to Nikki being immune suppressed it is difficult to keep her healthy long enough to have a surgery, (she has had at least 8 pneumonia infections in the last year and a half). We have her scheduled to receive the implant at the end of July, however without coverage Nikki will not be able to receive the implant.

Nikki is now three years old and has overcome so much adversity in her young life. According to the rules she is “disabled”, but with the cochlear implants that would enable her to hear she would no longer be “disabled”.

What would you do if Nicole was your daughter? You'd be fighting to move mountains -- just like her father is at this very moment.

As Wendell Potter -- a Cigna whistleblower -- has told America before, for-profit health insurance companies only pay out for major procedures when people shout loudly. He says patients denied health care need to be a "squeaky wheel."

Can we, the Daily Kos community, be a collective "squeaky wheel" for Nicole? Many thanks for your support.

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