What I say below is based only on an examination of my own psychology, motivations and reactions.  Nothing I say below is meant to characterize anybody else.

About a week ago, this former Edwards supporter finally, and after long thought, became a Clinton supporter.  At about the same time, I read a candidate diary that was excoriating her.  Until then I had mostly avoided those diaries and never expessed support for a candidate other than Edwards on the few I did read.  This time, I reacted to what seemed to me unsupported and insulting discourse by posting a message saying that the discussion had pushed me to support of Clinton.  That was not strictly true.  It had driven me to a declaration of support for her.  That declaration prompted several unpleasant comments, including one calling me a liar.

Following up on my argument yesterday that all Democratic candidate health care reform plans offer no more than partly government subsidized private insurance, similar to Medicare Advantage:

I am absolutely sick of hearing about the wonderful "Congressional Health Plan".  We are told again and again how generous it is.  And we are told even more often that all that is needed for a perfect universal health care plan is to "open the Congressional Health Plan" to the entire population.  Unfortunately, achieving affordable universal care is not this simple.

The healthcare reform plans of the leading Democratic Presidential candidates are similar.  They all entrust the organization of healthcare delivery to private insurance companies.  They all require community rating, prohibiting insurance plans from rejecting applicants or charging different premiums based on factors such as medical condition, age and occupation.  And they all call for some form of government agency to negotiate prices and benefits with insurance companies and to supervise the sale of the plans.  Apparently, benefits can vary among plans, but their actuarial value at each level of coverage must be equivalent.  That is, a plan may offer different combinations of benefits, premiums and co-pays, but the total value of the package must be equal.  Edwards and Clinton propose a public plan to compete with the private plans.

Not satisfied by denying millions of children access to medical care by vetoing the SCHIP bill, the Bush administration is doing its best to deny disabled people the benefits to which they are already entitled through the Social Security Program.  Recently, The New York Times published an article describing the disastrous administrative condition of the Social Security Disability program.

Recently, Paul Krugman took issue with the Obama campaign's stated position that Social Security is in a crisis meriting immediate rectification.  He quotes the Congressional Budget Office (CBO) Director,

The long-term fiscal condition of the United States has been largely misdiagnosed. Despite all the attention paid to demographic challenges, such as the coming retirement of the baby-boom generation, our country’s financial health will in fact be determined primarily by the growth rate of per capita health care costs.

On November 9, MedPac, the non-partisan commission that advises Congress on Medicare Policy, held a meeting (PDF, pp.313+) during which it examined several measures (PDF) of the quality and effectiveness of Medicare Advantage (MA) plans, those run by private insurance companies and paid by the Medicare Program to provide all medical services to Medicare beneficiaries.  As most readers of this diary know, these plans were created by the Medicare Modernization Act of 2003 (MMA).  A high point of the Republican Congress' privatization agenda, the MA program was touted as a triumph for "the free market" that would create competition with the public program and among private plans.  This competition would, in turn, reduce costs of the Medicare program and improve its quality.

US medicine is exorbitantly expensive and since 1970, that cost has grown 2.4 percentage points faster than the GDP  It is extremely difficult to imagine this rate of growth continuing.  In 1970, health costs amounted to 7.2% of GDP.   In 2005, they amounted to 16% of GDP.  They are projected to amount to 19.6% of GDP in 2016 if nothing is done to control them.  If health care costs continue to increase faster than does the GDP, health care will become the only thing we produce and consume in this nation.  That is not possible.  The ever increasing costs must be controlled.

The United Nations has raised a key question about the use of biofuels as substitutes for petroleum products.  In August, the UN Special Rapporteur on the right to food, the official responsible for informing the UN Human Rights Commission about existing and emerging problems with the world's food supply, warned that  

At the beginning of the second day of the Mukasey confirmation hearing, Senator Leahy asked Judge Mukasey (on C-SPAN Archive, AM Session, Day 2, first question)if he would allow a US Attorney to prosecute a Congressional Contempt proceeding.  Mukasey indicated that he would not allow such a prosecution by the Justice Department.

In Portland, Oregon a citywide electronic medical records project financially supported in part by the business community cannot be implemented because one of the primary savings it would facilitate, a major reduction in duplicate medical tests, is a significant source of hospital income.  Hospitals do not want to lose the income they collect from performing those tests.  

Throughout the nation private equity groups, not traded on stock exchanges and therefore not subject to mandatory public reporting of their activities, are buying nursing homes.  Two consequences often result from such consolidations:  The new owners cut costs, largely staff costs, with an almost inevitable decline in quality of care; they also organize themselves into such complex structures that it becomes almost impossible to identify and hold accountable the entities responsible for the injuries and deaths that often result from such cost-cutting, whether through regulation or litigation.

The Administration’s concerted effort to thwart effective consumer protection and to remove the incentive to improve safety beyond the minimum standards set by regulatory agencies reminds me of its politicizing of the Justice Department. Just as we have witnessed improper political considerations undermine our federal law enforcement agency for partisan gain, we are now witnessing agency rulemaking turned into a mechanism to immunize powerful corporations at the expense of ordinary Americans. Rather than issuing regulations based on facts and science to benefit the American people, the process has apparently been hijacked. The intended result of this politically-motivated version of rulemaking not only slams the local courthouse door shut on injured victims but it prevents State law, State regulators and State courts from protecting their citizens.

So said Senator Patrick Leahy at a Senate Judiciary Committee Hearing on September 12.

Except for Conyer's HB676 Medicare for All bill, all Democratic Health Care reform proposals. Edwards (PDF),  Richardson and Wyden, ignore Medicare.  For the most part, they interfere very little with other government financed programs in their plans.  They establish two systems that will operate simultaneously;  Medicare and other government health care programs, and a separate system built on existing private insurance supported to some degree by government subsidies for all others.

The financial industry and health insurers have found a new way to exploit US residents who are uninsured or under-insured.  They are offering "interest free" loans to allow people to pay for medical and dental procedures not covered by health insurance.

Seeing major profit opportunities, such players as Capital One, CitiBank, a unit of General Electric; health insurers such as United Health and numerous "upstarts" are entering the field.

When Bush asserted that the aftermath of the US Vietnam experience was a useful example of the dangers of withdrawing from Iraq, I could not stop myself from trying to imagine what the Neocons were trying to achieve by putting those words into Bush's mouth.  My ruminations led to a question about, for lack of a better term, "generational memory".  I was born a few years after the end of WWII.  Both of my parents served in that war, but their experiences were not a significant part of family lore.  I was alive during the Korean War, but had no conscious experience of it.  

Consequently, for me, both wars were as much historical events as WWI, in which the Grandfather I knew well fought.  By this, I mean what I know about these wars is not the result of personal experience, even second-hand through personally delivered accounts of participants.  My knowledge derives only from written and spoken accounts of news people, scholars or others whom I do not know, who probably have no direct experience of the events they are describing and interpreting, and who may have ideological or other biases.

Moreover, my education did not spend much, if any, time on the Korean War.

The Bush Administration's revision of FISA is not the only  outrage on individual privacy it has recently perpetrated.  At the same time the administration was pressuring Congress to give it unfettered access to phone calls between people in foreign countries and those in the US, it also pressured the European Union to gather and give to US authorities extensive personal data concerning passengers flying from Europe to the US.

Public Citizen's Trade Watch (PDF) has examined the text, released on June 25, of the Peru Free Trade Agreement as revised to bring it into conformance with the agreement that some Democrats in Congress reached with the administration.  Their initial findings are extremely unsettling.  The Peruvian government in the 1980s confronted political violence, hyperinflation, and a dramatic decline in the ability of the state to achieve any goals.  The President, Alberto Fujimori, sought advice from the Chilean dictatorship of Augusto Pinochet and took to heart the then dominant neo-liberal prescriptions that severe economic problems in "developing" nations could be resolved by structural reform measures, encompassing the privatization of state services, severe reductions in state-provided public services, the opening of economies to foreign investment and the reduction or elimination of state subsidies to allow the poor access to the basic necessities of life.

On June 6, Henry Waxman will hold a hearing to "assess" the FDA’s approval of Avandia in 1999.  Avandia is a drug marketed by GlaxoSmithKline to control elevated blood sugar in diabetics.  One of the company’s top sellers, it produced over $3 billion in revenue last year.  

The immediate reason for the hearing is a May 21, The New England Journal of Medicine (NEJM) (PDF, requires free registration) report that Avandia might increase the risk of heart attack by 43 per cent and the risk of death from cardiovascular causes by 64 per cent.  Cardiovascular disease is a major result of diabetes, so if a diabetes treatment increases the risk of dying from such disease, the treatment can only be evaluated as a danger to the millions of diabetics who have used it since 1999.

Introduction, Part I, Part II, Part III

This series has described the basis of the intellectual property regime protecting the pharmaceutical industry; various statutes that lengthened the protections granted by the initial statute, and some of the ways the industry games that system to extend its protections even further.  This conclusion will consider the possibility that the Hatch-Waxman intellectual property regime is becoming obsolete.  Hatch-Waxman was built on a balance between the needs of the innovator companies for what they consider a reasonable period of exclusive marketing rights and regulations and incentives to encourage generic firms to bring competing drugs to market as soon as that protection expired.