Month: February, 2018
Nigeria/Global: Promising Potential for Solar Mini-Grids
worker | February 26, 2018 | 8:33 pm | Africa, Analysis | Comments closed

AfricaFocus Bulletin February 26, 2018 (180226) (Reposted from sources cited below)

Editor’s Note

In contrast to fossil fuels, which require transportation of fuel to generation plants to produce electricity, and distribution networks to reach end-users of the power, solar energy is eminently scalable and flexible, from portable lanterns all the way to utility-scale photovoltaic solar farms. Stand-alone off-grid systems can power a single home or a school, and mini-grids can serve small communities.

The rapid expansion of battery storage has further enhanced the flexibility of such systems. The village of Gbamu Gbamu in Ogun State, Nigeria, provides a “template” that could be widely emulated in both technical and organizational terms, according to a new article in the industry newsletter Greenteach Media.

The feature story in this AfricaFocus Bulletin highlights this village-level minigrid with solar power and battery backup. Also included just below are brief excerpts and links to recent updates on renewable energy developments, in the United States (national and Puerto Rico), China, South Africa, and at the global level.

With the exception of policy regression at the national level in the United States, the trend towards rapid expansion of renewable power is striking. In the United States, despite the Trump administration, campaigns to move towards 100% renewable energy and halt any new fossil-fuel projects continue to grow (see, for example, https://gofossilfree.org/usa/ and https://www.sunrisemovement.org/). The targets are not only fossil-fuel companies but also local, city, and state governments and political candidates at all levels of government.

For a must-watch 4-minute video, with highlights of the “Fossil Free Fast” launch on January 31, 2018, see https://www.youtube.com/watch?v=wovzRGeaOR4.For previous AfricaFocus Bulletins on climate change and renewable energy, visit http://www.africafocus.org/intro-env.php

++++++++++++++++++++++end editor’s note+++++++++++++++++

Recent Updates on Renewable Energy

“How Trump’s Regulatory Rollback for America’s Energy Producers is Gaining Momentum,” EnerKnol, Feb. 20, 2018 https://enerknol.com/ | direct URL: http://tinyurl.com/y9uc27de“Federal agencies have reacted quickly to President Trump’s executive order, issued in March 2017, on reducing undue burdens on domestic energy production. On February 16, the Department of the Interior (DOI) announced the date for the largest sale of oil and gas leases in U.S. history. Scheduled for March 21, the sale will include all available areas in federal waters of the Gulf of Mexico. However, over the past year, the administration’s push for deregulation has prompted numerous legal challenges creating uncertainty in the industry.”Emma Foehringer Merchant, “Grid Defection Is On the Rise in Puerto Rico,” Greentech Media, Feb. 16, 2018 https://www.greentechmedia.com – Direct URL: http://tinyurl.com/yd4bpw3v

“This week, Sonnen and Pura Energía, a local solar installer, announced they’d brought two storage-plus-solar systems online at SU Matrullas. Now, Castillo says that teachers can use their computers, the school’s 150 students have enough light to do homework, the school’s kitchens have running refrigerators, and the community has an off-grid center to help them weather the next storm. … Even after grid-connected power becomes available, said Castillo, the school plans to stay disconnected and run on its own energy ”

Oliver Milman, “New York City plans to divest $5bn from fossil fuels and sue oil companies,” The Guardian, Jan. 10, 2018 https://www.theguardian.com/ – direct URL: http://tinyurl.com/y8k6uypd“City is seeking to lead the assault on climate change and the Trump administration with a plan to divest $5bn from fossil fuels and sue the world’s most powerful oil companies over their contribution to dangerous global warming. … De Blasio said that the city is taking the five fossil fuel firms – BP, Exxon Mobil, Chevron, ConocoPhillips and Shell – to federal court due to their contribution to climate change.”Amy Myers Jaffe, “Green Giant: Renewable Energy and Chinese Power, Foreign Affairs, March/April 2018 https://www.foreignaffairs.com/ – Direct URL: http://tinyurl.com/ya82rgk4“China aims to make itself the center of the clean energy universe, selling its goods and services to help other countries avoid the environmental mistakes it now admits were part of its recent economic growth. … Just as China’s big move into solarpanel manufacturing brought down the costs of that technology, so the prices of batteries, electric cars, and carbon capture and storage will likely collapse as China invests.”Bloomberg, “Runaway 53GW Solar Boom in China Pushed Global Clean Energy Investment Ahead in 2017,” Jan. 16, 2018 https://about.bnef.com/ – Direct URL: http://tinyurl.com/yaq27e6m“Solar investment globally amounted to $160.8 billion in 2017, up 18% on the previous year despite these cost reductions. Just over half of that world total, or $86.5 billion, was spent in China. This was 58% higher than in 2016, with an estimated 53GW of PV capacity installed – up from 30GW in 2016.”Anton Eberhard & Amory Lovins, “South Africa’s Electricity Choice: Renewable Energy is a win-win,” Daily Maverick, Feb. 2, 2018 https://www.dailymaverick.co.za/ – Direct URL: http://tinyurl.com/yafublze“Importantly, most of South Africa’s R193-billion in renewable projects were financed by banks and private investors, including R53-billion from abroad. It’s not hard to see why: a solar plant built in sunny South Africa pays for itself twice as fast as one in Italy. And while big renewable projects are very fast, small-scale renewable projects, such as solar power for a home or a village, can be up and running within weeks.”

In Nigeria, a Template for Solar-Powered Minigrids Emerges

How a unique partnership, innovative financing and stubborn persistence created a model for localized solar and batteries.

by Chris Warren

Greentech Media, February 20, 2018 https://www.greentechmedia.com – Direct URL: http://tinyurl.com/y7dmflmj

On a humid November day in the small Nigerian village of Gbamu Gbamu (pronounced bomb-ou bomb-ou), Akinola Oduola clambers down a wooden ladder propped against a minaret that overlooks a tight cluster of adobe, wood and concrete homes.

“This is my work,” Oduola says by way of introduction, gesturing toward the mosque that is taking shape nearby.

This is not hyperbole. Oduola has spent the past three years single-handedly willing this mosque into existence. Hard work is important for those who call Gbamu Gbamu home. When he’s not building his mosque, Oduola is a welder and motorcycle repairman — an in-demand profession in a town where the bulk of the population travels to and from Gbamu Gbamu along a deeply rutted 10-kilometer dirt road.

For Oduola, it’s the price of doing business: His ability to weld depends on a generator that slurps between 30 and 35 liters of diesel per week.

But things are about to change dramatically for Oduola and a large percentage of his 3,000 fellow villagers, thanks to a construction project that has taken shape far quicker than the mosque. From nearly any vantage point in Gbamu Gbamu, one can look upward to see newly installed utility poles and wires.

This new distribution system will soon be delivering continuous power from a 30- kilowatt installation of solar panels located on a nearby hillside that the local government happily donated to the project’s developers, Lagos-based Rubitec Solar. At night, a trailer full of batteries will keep the electricity flowing, and a large generator will provide backup power in case the combination of solar and batteries are ever unable to satisfy demand.

 

Akinola Oduola works on a motorcycle in Gbamu Gbamu. Photo credit: Winrock International/Bobby Neptune.

Powering a better life

It’s hard to overemphasize what a change this newly installed minigrid represents to a rural village in Nigeria. Access to power is one of Nigeria’s most common and challenging chasms, a dividing line that determines a community ’s quality of life and prospects.

But by embracing a solar-powered minigrid, Gbamu Gbamu is set to vault past much larger grid-connected urban areas in terms of reliable access to electricity. “ This fills an enormous unmet need in Nigeria. Half of the country is not on the electrification network. The half that is connected receives very little electricity, usually just a few hours’ [worth] each day. And the other half may not be connected for a decade, if ever,” says James Lykos, deputy director of the Office of Economic Growth and Environment at the U.S. Agency for International Development’s Nigeria mission, which has supported the development of Gbamu Gbamu’s minigrid.

“When you have electricity, you can engage in better economic opportunities, and it helps resolve poverty. This can have a transformative impact on rural communities, and indeed, the country as a whole,” says Lykos.

Developing minigrids throughout Nigeria, including the one at Gbamu Gbamu, is one of the main components of the Nigerian Energy Support Program (NESP), which is co-funded by the European Union and the German government and is being implemented by GIZ, the technical arm of the German Federal Ministry for Economic Cooperation and Development. In addition to Gbamu Gbamu, five other minigrids have been developed during the first phase of NESP. USAID partnered with GIZ to support two of the minigrids, including the one in Gbamu Gbamu.

A minigrid model for Nigeria

In a country with an estimated population of 186 million, a single solar-powered minigrid that is transforming a few thousand rural lives could understandably be ignored as a happy novelty. But there’s something more profound taking shape.

The innovation, collaboration and persistence required to develop and construct these minigrids have established a template that Nigeria can follow to deliver the benefits of electrification to millions of people around the country.

Enthusiasm for minigrids is simply an acknowledgement of the economic and logistical realities of Nigeria’s power grid.

“Extending the grid is very expensive. There are many communities — most, actually — where extending the grid is a net present value-losing proposition. You will never get enough money out of these communities to justify doing this,” says Javier Betancourt, the chief of party for the USAID-funded Renewable Energy and Energy Efficiency Project (REEEP) in Nigeria, which is being implemented by the U.S.- based NGO Winrock International.

“You can’t electrify everybody using the grid or large-scale generation. The best solutions are minigrids. This is the future. But there needs to be a template in Nigeria for how this is going to evolve,” says Betancourt.

Devising and implementing a replicable template has been the core mission of REEEP since its launch in 2013. The challenges and roadblocks have been daunting.

While minigrids may be the best and only solution for electrifying Nigeria, their development has been stunted for a host of reasons, including the lack of technically competent minigrid designers and solar installers.

“There’s a very large problem in Nigeria with faulty installations that have created this perception problem,” says Betancourt. “There are all these dead solar systems all over the place that have given people the impression that solar doesn’t work, and it’s usually due to shoddy installation work.”

To address this immediate problem and build a skilled workforce, REEEP and GIZ worked with dozens of international experts to develop a rigorous and standardized curriculum that is now used at 13 training institutions across Nigeria.

Alabi Abiodun of Rubitec Solar shows off the batteries powering the Gbamu Gbamu minigrid. Photo credit: Winrock International/Bobby Neptune.

Budding Nigerian minigrid developers and investors also needed assistance figuring out which communities could feasibly support a minigrid. In part, that meant finding villages that were far enough away from the power grid that there was no chance that it would be extended anytime in the near future. More importantly, developers and investors needed to know which villages had sufficient population and economic activity to make the investment required to build a minigrid worthwhile.

“Are there productive activities going on to show that they have the capacity to pay for the cost of electricity?” says Anayo Okenwa Nas, the CEO of Nayo Tropical Technology Ltd., a developer of minigrids in Nigeria. “Is it a fishing community? A timber community? An agrarian processing community?”

To help developers focus their attention and resources on viable sites, GIZ performed geographic information system data analysis in five Nigerian states to locate which villages had sufficient load to justify a minigrid. This work has resulted in a tool that will soon be launched by the Nigerian Ministry of Power that developers and investors can use to streamline their efforts. “If I want to set up a project in Nigeria, I can quickly see whether it makes sense to invest and where,” says Ina Hommers, who heads up NESP for GIZ. “This is something we want to expand because no investor has time or money to do this from scratch.”

The biggest hurdle of all: Money

Of all the obstacles standing in the way of solar-powered minigrids delivering the benefits of electricity to millions more Nigerians, none has been as complicated and challenging to address as financing. Anyone considering building a minigrid would have to find money to pay for both the solar panels and batteries required to generate and store electricity as well as the poles, wires and meters necessary to distribute it to homes and businesses.

These combined costs make it impossible for minigrid developers to attract investors. But it’s also not a financial burden that generation companies around the world are typically expected to cover. “They never pay for their own distribution, ” says Betancourt. “If you think about it fairly, nobody in any country has ever paid for their own grid. Generation companies get the grid through a subsidy or the government, or someone comes in with a grant and gives the thing away.”

To address this challenge, REEEP and GIZ devised what Betancourt describes as the “split asset model.” Instead of trying to convince banks and other financial institutions to invest in a minigrid project as a whole, REEEP separated the distribution and generation components. For the first five minigrid projects in Nigeria, including in Gbamu Gbamu, GIZ provided a grant to cover the distribution costs, which account for roughly half of the total project expenses.

REEEP and GIZ initially turned to Nigeria’s central bank and commercial banks to provide funding that developers needed for the solar panels, batteries and other generation components required for the minigrids. Because renewable energy is a nascent industry in Nigeria, this first meant educating bankers about how to evaluate potential minigrid projects.

“We provided training with banks on small renewable energy projects. Banks don ’t usually understand the rationale of such projects,” says GIZ’s Hommers. “You can’t really count on the experience of other projects because the sector is so young. To banks, that is very high risk.”

Though there’s optimism that the extensive outreach and education REEEP and GIZ provided to Nigerian banks and other investors will facilitate project financing in the future, an economic collapse and devaluation of the country’s currency in 2015 quickly halted all the progress that had been made. “Everything came crashing down exactly when we were going to get our first minigrid financed,” says Betancourt. “For two years, we were stumped on how to get them financed. ”

Crowdfunding to the rescue

But that all changed when Betancourt met a representative of the German crowdfunding platform Bettervest at an event in Lagos. Bettervest allows individuals to invest and earn a return on renewable energy and energy efficiency projects around the world. The crowdfunding platform was exploring an entry into the Nigerian market and had formed a partnership with GIZ to help it understand the unique dynamics at play in the country. “Bettervest had a very strong interest to pilot two projects before deciding if they wanted to enter the Nigerian market for other activities, ” says Hommers.

Though GIZ was eager to find financing for the pilot minigrids, it was also reluctant to expose Bettervest’s investors to any unnecessary risk. “We lack the financial ability to say this is safe and sound,” says Hommers. Instead, GIZ relied on the financial expertise of REEEP’s Betancourt. Betancourt had worked previously as an investment banker, a financial regulator for the Mexican government and for NGOs like Winrock, where one of his specialties over the past decade has been improving access to finance in the developing world.

Betancourt applied all of that experience to help Bettervest lower (though not eliminate completely) the risk faced by its investors. “I do the financial due diligence for them here. I provide Bettervest the credit reports, the tax clearances, the reputational checks and the document verification,” he says. “GIZ helped them with lawyers to get contracts and together we lowered their entry costs. That is how we got them to finance our minigrid projects.” Once actually posted to the Bettervest website, it took 106 days for investors to pony up the 224,100 euros (around $260,000) required for Rubitec to build the generation component of the project. Bettervest investors are expecting a 10 percent return on their investment in Gbamu Gbamu.

A sustainable model for the future?

Though the pilot minigrid projects GIZ and REEEP have helped shepherd into existence will clearly have a big impact on the communities where they are located, the obvious question is whether this development approach can be scaled up. Though REEEP is coming to an end in early 2018, GIZ has already committed to provide grants that will cover the distribution costs of 20 more minigrids.

Obviously, GIZ and other donors can’t supply grants for the thousands of minigrids Nigeria will need to bring clean and reliable electricity to all of its citizens. Betancourt has been working with both the Nigerian Rural Electrification Agency as well as individual state governments to explore ways to take funds typically devoted to extending the central grid and use it instead for minigrids.

“Each state government gets a grid extension budget from the federal government each year to extend the grid,” Betancourt says. “What they can do now is use that budget to give grants to the project developers for the distribution and the metering and the Nigerian minigrid developers do the rest on a purely commercial basis.”

In other words, it’s a way to utilize the so-called “split asset model ” to develop the minigrid in Gbamu Gbamu over and over again. “We believe these minigrids strongly prove there is private-sector interest. This is a bit of a game-changer in sub-Saharan Africa,” says Hommers.

There are certainly challenges ahead. The risk of devaluation of the Nigerian currency, the naira, is always a worry for investors. Corruption also remains a major problem. Training legions of skilled solar installers and minigrid designers will be of little use if there aren’t projects for them to work on. “A lot of this will atrophy if the people who were trained don’t get to utilize their skills and work and bring renewable energy projects to completion,” says USAID ’s Lykos.

The new distribution system in Gbamu Gbamu. Photo credit: Winrock International/Bobby Neptune.

In many ways, though, the future of solar-powered minigrids in Nigeria will depend on the success of people like Bolade Soremekun. Soremekun is the CEO of Rubitec Solar, the company that built the Gbamu Gbamu minigrid. Soremekun earned an MBA at New York University and spent years working for big multinational corporations like Johnson & Johnson and GlaxoSmithKline. But he always wanted to come home to Nigeria. “I wanted to achieve and do things in Nigeria,” he says.

For years, working in solar meant organizing conferences, an admittedly time- consuming and money-losing hobby compared to Soremekun’s successful pharmacy business. “My pharmacy staff once called a meeting and said, ‘Stop this crazy thing you are doing about organizing conferences,’” he says. “’You are promoting solar, good, but you are not making money.’”

Lately, though, solar and minigrids are looking more and more attractive. It used to be that meetings with banks would frustrate Soremekun because they would either not offer financing at all, or would only offer it at exorbitant interest rates. That has already started to change. Soremekun believes it will change faster once bankers see the reliable cash flow that will be generated when customers in Gbamu Gbamu prepay their electricity bills using mobile money accounts.

“I think if the pilots go well, and I hope they do, they are going to start a momentum towards minigrids,” he says. “I think financing will be easier. The banks are going to see the cash flow right there in front of them, and they ’ll say, ‘OK, we want to do the next minigrid and then the next minigrid.’”

Rubitec already has plans to construct between five and 10 minigrids over the next two years, with 100 other potential sites already pinpointed. With more and more projects, Soremekun believes minigrids will become easier to develop and implement. “What attracts investors to minigrids is scale. They don’t want one minigrid; they want hundreds of them. Then it becomes a good business,” he says. “Solar is the best space to be in right now in terms of business, I think. There are so many huge opportunities.”

Minigrids have allowed Soremekun to make the kind of difference that compelled him to return to Nigeria. At first, people in Gbamu Gbamu didn’t really believe the minigrid would actually be built. “There are too many promises that are not fulfilled,” he says. “They have just accepted their fate, to live their lives as best they can. This changes that. Their lives could be better. That’s why I get up every morning excited.”

***

Chris Warren is a freelance writer based in Arkansas. The reporting trip to Nigeria was funded by Winrock International.

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AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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US Collapse – the Spectacle of Our Time
worker | February 26, 2018 | 8:28 pm | Analysis | Comments closed

https://sputniknews.com/columnists/201802251061983205-us-collapse-spectacle-of-our-time/

Statue of Liberty

US Collapse – the Spectacle of Our Time

© AP Photo/ Richard Drew
Columnists

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Finian Cunningham
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May you live in interesting times, goes the Chinese proverb. Few can doubt that we are indeed living in such an interesting time. Big changes are afoot in the world, it seems.

None more so than the collapsing of the American Empire.

The US is going through an historic “correction” in the same way that the Soviet Union did some 30 years ago when the latter was confronted with the reality of its unsustainable political and economic system. (That’s not meant to imply, however, that socialism is unviable, because arguably the Soviet Union had fatally strayed from its genuine socialist project into something more akin to unwieldy state capitalism.)

READ MORE: Uncle Sam Rolls in His Grave: US Youth Favor Socialism Over Capitalism

In any case, all empires come to an end eventually. History is littered with the debris of countless empires. Why should the American Empire be any different? It’s not. Only arrogant “American exceptionalism” deludes itself from the reality.

The notable thing is just how in denial the political class and the US news media are about the unfolding American crisis.

This is partly where the whole “Russiagate” narrative comes into play. Blaming Russia for allegedly destabilizing US politics and society is a cover for denial over the internal rot facing the US.

Some may scoff at the very idea of an “American Empire”. That’s something Europeans did, not us, goes the apologist for US power. The quick retort to that view is to point out that the US has over 1,000 military bases in more than 100 countries around the world. If that is not a manifestation of empire then what is?For seven decades since the Second World War, “Pax Americana” was the grandiose name given to US imperial design for the global order. The period was far from peaceful as the vainglorious name suggests. Dozens of wars, proxy conflicts and violent subversions were carried by the US on every continent in order to maintain its empire. The so-called “global policeman” was more often a “global thug”.

That US empire is now teetering at the cusp of an emerging multipolar world order led by China, Russia and other rising powers.

When US leaders complain about China and Russia “reshaping the global order” to reflect their interests what the American leaders are tacitly admitting is the coming end of Washington’s presumed hegemony.

Rather than accepting the fate of demise, the US is aggressively resisting by denigrating China and Russia’s power as somehow illegitimate. It’s the classic denial reaction of a sore loser.

So, what are the telltale signs that the US is indeed undergoing a seminal “correction” — or collapse?

The heyday of American capitalism is well passed. The once awesome productive system is a skeleton of its former self. The rise of massive social poverty alongside obscene wealth among a tiny elite is a sure sign that the once mighty American economy is chronically moribund. The country’s soaring $20 trillion national debt is another symptom of chronic atrophy.

Recent self-congratulatory whooping by President Trump of “economic recovery” is like the joy felt from looking at a mirage. The roaring stock market is an elite phenomenon which can just as easily slump over night.What the champagne bubbles can’t disguise is the structural failing of US capitalism to reverse exploding inequality and endemic poverty across America. The national prowess of US capitalism has been superseded by global capitalism where American corporations among others scour the planet for cheap labor and tax havens. There is no going back to a supposed golden age, no matter how much Trump crows about “America First”.

The other side of the coin from historic US economic demise is the concomitant rise in its militarism as a way to compensate for its overall loss of power.

It is no coincidence that since the end of the Cold War following the dissolution of the Soviet Union, US military interventions around the world have erupted with increased frequency and duration. The US is in a veritable permanent state of war actively deploying its forces simultaneously in several countries, particularly in the oil-rich Middle East.

Washington of course gives itself a fig leaf cover by calling its surge in militarism a “war on terror” or “defending allies”. But, increasingly, US war conduct is seen for what it plainly is — violation of international law and the sovereignty of nations for the pursuit of American imperial interests.

In short, the US is patently lashing out as a rogue regime. There’s no disguising that fiendish fact.

READ MORE: US Coalition Should Stop ‘Occupation Attitude’ in Syria — Russian Envoy to UN

In addition to waging wars, bombing countries, sponsoring terrorist proxies and assassinating enemies at will with drones, Washington is increasingly threatening others with military aggression. In recent months, North Korea and Iran have been openly threatened based on spurious claims. Russia and China have also been explicitly warned of American aggression in several strategic documents published by the Trump administration.

The grounds for American belligerence are baseless. As noted, the real motive is to do with compensating for its own inherent political, economic and social crises. That then amounts to American leaders inciting conflicts and wars, which is in itself a grave violation of international law — a crime against peace, according to Nuremberg principles.

The American Empire is failing and flailing. This is the spectacle of our time. The Western mainstream news media are either blind, ignorant or complicit in denying the historic collapse. Such media are indulging reckless fantasies of the US political class to distract from the potential internal implosion. Casting around for scapegoats to “explain” the deep inherent problems, the political class are using Russia and alleged Russian “interference” as a pretext.

READ MORE: ‘Collapse’ but ‘Favorable Contact’: Kremlin Spokesman Talks US Relations

World history has reached a foreboding cross-roads due to the collapsing of the American Empire. Can we navigate a safe path forward avoiding catastrophic war that often accompanies the demise of empires?

A lot, it seems, depends on ordinary American people becoming politically organized to challenge their dysfunctional system run by and for the elites. If the American people cannot hold their elites to account and break their corrupt rule, overhauling it with something more equitable and democratic, then the world is in peril of being plunged into total war. We can only but wish our American brothers and sisters solidarity and success.

The views and opinions expressed in this article are solely those of the author and do not necessarily reflect those of Sputnik.

‘I don’t understand why civilians need military weapons’ – Condi Rice
worker | February 26, 2018 | 8:24 pm | political struggle | Comments closed

https://www.rt.com/usa/419802-condoleezza-rice-military-gun-debate/

‘I don’t understand why civilians need military weapons’ – Condi Rice

‘I don’t understand why civilians need military weapons’ – Condi Rice
Condoleezza Rice doesn’t “understand why civilians need to have access to military weapons.” The former Secretary of State’s comments are seemingly at odds with her support for the 2nd Amendment.

Rice, George W Bush’s secretary of state, was speaking to radio host Hugh Hewitt on Friday when she questioned the need for military weapons. “I think it is time to have a conversation about what the right to bear arms means in the modern world,” she said.

“I don’t understand why civilians need to have access to military weapons. We wouldn’t say you can go out and buy a tank,” she added.

Rice’s loyalty to the 2nd Amendment is in some part tied to her childhood in Birmingham, Alabama, which saw her exposed to violence against the black community by the Ku Klux Klan. Recalling how her father and other men in the community protected them at that time, Rice said, “I think it’s a pure version of the second Amendment, as a matter of fact, the right to bear arms.”

“The rights that we have in the Constitution are indivisible,” Rice said. “We can’t throw away the Second Amendment and keep the First.”

While President Donald Trump and the National Rifle Association have called for teachers to be armed in the wake of the Florida school shooting that killed 17, Rice doesn’t think arming teachers with guns is “going to be the answer.”

“I don’t really like the idea, frankly, of a gun in my classroom,” she said. Rice teaches political science at Stanford University.

“Look, if people need to train people to protect our schools, and perhaps even communities want to consider whether or not they need guards to protect the schools, it’s a sad thing to think that we might, then that’s something that we should look at,” she said.

The End of Insurance?
worker | February 23, 2018 | 8:03 pm | Health Care | Comments closed

The Sun Interview

The End Of Insurance?

Andrew Coates On Fixing Our Broken Healthcare System

507 - Kral - Frisch
© Jon Kral

Due to a proofreading error, the print version of this interview left readers hanging: the last word was missing.

The word is “take.”

We are embarrassed by the mistake and apologize to our readers, to interviewer Tracy Frisch, and to Dr. Coates.

— Ed.

 

As a boy growing up in rural upstate New York, Andrew Coates dreamed of becoming a physician. After high school he went through a period of rebellion, dropping out of college and supporting himself with jobs as a carpenter and in factories and restaurant kitchens. Returning to his education, he earned a master’s degree in American history before finally entering medical school at Columbia University at the age of thirty-two. Coates jokes that, unlike most doctors, he “once worked for a living,” adding that he believes his experiences as a young man have benefited him as a physician.

After a residency in internal medicine, Coates took a position at an Upstate New York hospital. There he saw how patients and their families were often made destitute by the high cost of healthcare. In particular, nursing-home care, a necessity for many who survive a devastating illness, is unaffordable for most people. Medicare covers everyone over the age of sixty-five but allows only limited stays in nursing facilities. Medicaid — a joint state-and-federal program for poor Americans — does cover long-term nursing-home care. But to become eligible for Medicaid, people must first empty out their bank accounts and sell their homes and other assets to pay medical bills. Coates saw medical expenses lead to the forfeiture of a family farm, even though three generations were living on the land.

Coates went on to further specialize in hospice and palliative care, which focuses on relieving the pain and stress of serious illnesses. (Hospice patients, for whom death is expected, make up a limited number of palliative-care patients.) In his palliative-care practice he helps people make difficult decisions about care, finding choices that reflect what’s most important to them, with an emphasis on quality of life for the patient and the family. Presently a full-time hospital-medicine physician, he also teaches medical students, interns, and residents at patients’ bedsides as well as in the classroom as a professor of medicine at Albany Medical College.

Coates’s early experiences in the profession have made him an advocate for a single-payer healthcare system, in which the government pays the medical bills of all its citizens, not just the poor and elderly. A public, national health-insurance program would eliminate the need for private health insurance altogether. Vermont senator Bernie Sanders made support for single-payer healthcare a centerpiece of his campaign for president in 2016. Coates believes we need to go a step further than Sanders proposes and also abolish profit-seeking in medicine.

I first became aware of Coates’s work many years ago when I heard him speak at a rally. He is the founder of the healthcare advocacy group Single Payer New York (singlepayernewyork.org) and past president of Physicians for a National Health Program, a physician organization that advocates for a single-payer healthcare system (pnhp.org). He and I spoke on a muggy evening last fall at his home, an old farmhouse surrounded by a suburban neighborhood. We talked for several hours about the inadequacies of the current U.S. healthcare system and his vision of what might replace it. He told me that he continues to find medicine an “incredibly compelling human endeavor.”

 

507 - Andrew Coates

ANDREW COATES
© Mark Almberg

Frisch: You’ve been an outspoken champion of a single-payer (publicly funded) healthcare system, which is sometimes known as Medicare for All.

Coates: In my view, single-payer is an incremental step, a reform that pushes us toward a truly efficient and responsible system of healthcare. Single-payer is far from perfect and will not work without a few hard rules, including the elimination of out-of-pocket patient spending for necessary care, a system to annually budget for anticipated health needs for each community, and completely banning profiteering in medicine.

Frisch: Including for pharmaceutical companies and medical-equipment manufacturers?

Coates: Yes. There should be no profiteering in the delivery of healthcare. I’m not talking about whether highly trained physicians, nurses, or their support staff should be able to make a handsome middle-class living. As a society we should be proud to support professional caregivers. That’s different from people making money simply because they own the laboratory or the hospital or the distribution system. For example, nursing homes in the U.S. are mostly owned by private-equity firms like Warburg Pincus, Bain Capital, GE Capital, the Carlyle Group, and others. These corporate owners in turn hire myriad subcontractors to run every aspect of the home, from the kitchen to the janitorial service to the electronic health records to the laundry. And at every step there is someone taking a profit out.

I think it’s appalling that one person’s illness would be an opportunity for another to make money. The care of human beings should not be a commodity. Since the dawn of time people have done their best to tend to the injured or sick. That’s something very basic to humanity. When caregiving becomes a commodity, the goal of health collides with the goal of wealth. In American healthcare today an unbelievable number of interlopers have entered the fray. Their job is to figure out how to extract funds that could otherwise have gone to help the sick.

But the problem isn’t just that there’s money going out of the system. It’s also that this enormous, unnecessary insurance bureaucracy sits on top of the system, making it extremely inefficient.

Research shows that for-profit medical institutions produce inferior outcomes compared to not-for-profit institutions. If we change to a single-payer system, a bedrock requirement should be that all medicine be not-for-profit.

Frisch: What’s wrong with a for-profit system?

Coates: For one, money is often spent in the wrong places. In our town there are two big hospitals, and both have fancy parking garages and gleaming pavilions with pianos that play themselves. I’m not sure how all of this has improved the quality of care.

Frisch: It sounds like they’re just trying to attract patients.

Coates: Sure, if you have a spiffy parking garage and a nice pedestrian bridge that leads right into the ambulatory-surgery center, maybe that gives you a leg up on the competition. These hospitals are not-for-profit, by the way, but they’ve learned to operate like for-profit hospitals in order to compete. Wouldn’t it be something if the people of the community could decide what the experience of getting care should be like, rather than having competition drive showy expenditures? We could address real concerns, such as preventive care.

Frisch: The Affordable Care Act — also known as Obamacare — required that certain preventative services, such as cancer screenings and immunizations, be offered without deductibles, to make it more likely that people will get them.

Coates: Ending out-of-pocket costs is another part of what I see as the bedrock of healthcare reform. When people have to pay out of pocket for necessary care, they often avoid getting it. The policy term for out-of-pocket payments — whether it’s copays, deductibles, coinsurance, or cash payments — is “user fees.” Study after study finds that user fees amount to bad health policy.

Frisch: But if there’s no cost to the patient, what will prevent people from willy-nilly asking for all kinds of tests and procedures and specialists? Wouldn’t we have a hypochondriac’s paradise?

Coates: There’s almost no evidence that this would happen. In places where there’s been an expansion of access to healthcare — like when the U.S. enacted Medicare in 1965 — the system was not sunk by a glut of people seeking unnecessary treatment.

Frisch: A few days ago I spoke to a man who had retired from the police force with good health coverage and was now on Medicare and purchasing supplemental private insurance. He insisted that everyone should pay for healthcare, even poor people on Medicaid.

Coates: What about the nursing-home patients who can’t possibly work because they need round-the-clock care? What about sick children who aren’t yet old enough to have a job or will never be able to work? Is there a right time of life to get cancer, or have a heart attack, or contract an overwhelming infection?

Frisch: I think this former police officer feels he paid his dues. Why should he pay more to care for someone who doesn’t work?

Coates: If we all pay a small percentage of our income into the system, we can ensure that everyone gets care. Sure, some of us, disabled by illness, will not be able to pay. But the rest of us should proudly contribute, with the understanding that we are building a system that protects us all. Who knows when we might suffer an illness that renders us unable to work and therefore unable to contribute? Providing care to the most vulnerable is not altruism. It’s a form of social solidarity that benefits us, too, because someday we will likely need that system ourselves.

Frisch: Some people think undocumented immigrants are abusing the system.

Coates: If you’re undocumented and receive a paycheck, as most undocumented workers do, money is withheld from that check for Social Security and Medicare benefits that you will never be eligible for, because you don’t have a legitimate Social Security number. All of that money goes into the public till. Incidentally, the retired police officer you mentioned, who’s getting Medicare benefits, has his healthcare paid for in part by undocumented laborers. Meanwhile an undocumented worker who paid into Medicare and Social Security will never receive either. Our country’s cruelty toward undocumented immigrants is most shockingly revealed by medical deportations. Sick, hospitalized patients are flown by air ambulance back to their country of origin. This is unethical and a violation of human rights. Some are patients who need dialysis to stay alive after kidney failure. Many times the patient’s home country lacks the infrastructure to provide dialysis, so deportation can amount to a death sentence.

Frisch: Was the Affordable Care Act a step forward?

Coates: The ACA was one step forward, two steps back. It expanded Medicaid eligibility — in the states that chose to participate in the expansion — and also increased funding to health centers that provide care for underserved populations. These measures helped patients gain access to healthcare who previously couldn’t afford it.

Frisch: What about the individual mandate, which requires everyone to buy insurance?

Coates: The mandate has a curious history. Originally thought up by the Heritage Foundation, a conservative think tank, it was first implemented in Massachusetts by the private-equity millionaire and Republican governor Mitt Romney. The idea was to bring the magic of the marketplace to health insurance by forcing everyone to buy it or pay a fine. Barack Obama, the Democratic president, chose to champion the idea for his signature reform effort, initially expecting bipartisan support.

Under the ACA around 20 million Americans gained coverage, mostly through the expansion of Medicaid. These people would not have had insurance otherwise, and I’m sure this saved lives. But many features of Obamacare got much more credit than they deserved. For example take the policy of letting parents keep grown children on their insurance up to the age of twenty-six. The twenty-somethings who benefited all had parents with adequate insurance. That’s a relatively affluent portion of the population. Millions of young adults whose parents had inadequate or no coverage were left out. Nevertheless, within that group who did benefit, there were people who had life-threatening illnesses caught early and as a result got treatment.

Frisch: That’s the one step forward.

Coates: Yes. Then there are the two steps back. To make premiums as low as possible, the Obama reform opened the door for more plans with high deductibles or narrow networks of providers. Deductibles have risen and risen. We routinely hear about patients spending thousands of dollars out of pocket before the insurance kicks in. In short, costs have been pushed onto the sick.

In addition, the Affordable Care Act led to an enormous wave of corporate conglomeration — among hospitals, primary-care networks, insurance companies, and pharmacies — creating huge new entities, all in the search for profit and market share. Large corporate healthcare companies drive costs up, not down.

Frisch: If we had a publicly funded system, wouldn’t there be a constant danger that the party in power might deprive it of resources?

Coates: Sure, but healthcare funding always requires public vigilance, scrutiny, and participation. What better way is there to monitor health outcomes than to make the system public? Some government services are already widely viewed as necessities: having an adequately equipped fire department, for example. An effort to turn firefighting to a private, profit-seeking venture seems ludicrous. In healthcare, if people were used to having access to top-quality care, I believe it would be difficult to starve the system of resources. The health of the people — I can’t think of a more legitimate topic of public discourse for any modern democracy.

Frisch: Would health-insurance companies disappear?

Coates: Hopefully, yes. Competing private health-insurance companies are a very inefficient way to fund healthcare. The idea of insurance is that the larger the risk pool, the more evenly the costs are distributed. So the most perfect risk pool would be everyone in, nobody out. But that’s not how private insurance works. Instead it’s a perverse competition. Insurance companies are not competing to give the best coverage to those who need it most: the sickest among us. They don’t even want those customers. Health-insurance companies compete to find the patients who are both healthy and wealthy, so they will buy policies but not use them.

Frisch: Many employers offer some form of health insurance to their employees. Does that system work?

Coates: Big corporate employers spend so much on healthcare that it affects other decisions they make. Some employers are starting to realize that universal access to healthcare would give them more freedom. There was an entrepreneur in West Virginia who wanted to start an aerospace manufacturing company about a decade ago. I met him. He wanted to put the plant near his hometown, but his investors insisted he put it in Ontario, Canada, because the company’s healthcare costs would be so much less there.

On the other hand, some employers use employer-sponsored health insurance as a form of control over workers.

Frisch: Because employees don’t dare quit?

Coates: There’s job lock. If you have a sick person in your family on your plan, you’re afraid to leave your job, because your loved one needs the coverage. But I’m also thinking of how messed up it is to depend on your employer or your spouse or your parents for health coverage. Other forms of social control include how some employers demand a note from a doctor if you take sick days. And when you start a new job, if it offers health insurance, there’s a probationary period — three, six, or even twelve months — before you have access to the benefits. And I’ve heard of other insidious practices, like smokers having to pay more than nonsmokers and employees having to prove that they exercise.

Frisch: Some employees go on strike because their healthcare is so bad.

Coates: If you try to organize a strike, you will find your health insurance canceled as soon as the strike starts. Most union contract bargaining gets stuck over health benefits these days. With universal healthcare, unions could instead focus on wages and working conditions. Single-payer reform would strengthen the unions and prove incredibly liberating for working people.

Frisch: What do you think fuels the intense antipathy toward universal healthcare among so many politicians in both major parties?

Coates: I can’t say. In my interactions with everyday people, I don’t find much, if any, antipathy toward universal healthcare. Last week I was in Long Lake, New York, in the Adirondacks. I didn’t hear opposition there to the idea that every human being who needs medical attention should get it. Politicians loudly oppose universal healthcare, and yet they stop short of openly advocating that some human beings should be denied the care they need. The author of a U.S. Senate bill that would have enormously curtailed Medicaid across the country, throwing millions of people off the rolls, went on TV and lied and said his bill wouldn’t hurt those people. Talk-show host Jimmy Kimmel, whose son was recently born with a congenital heart condition, called out his lies on late-night TV.

Virtually all developed nations provide universal access to healthcare in some way. The single-payer model has worked well in Taiwan and Canada. Germany is an example of a multi-payer system, but government regulation ensures that all costs are uniform, whether you’re insured through a community organization or a company or a religious group. Scotland has a purely public health service, where every physician and nurse gets a paycheck from the government. Spain has the right to healthcare in its constitution. We could go on. The only developed country that has designed its healthcare system to leave people out is the United States.

It’s appalling that one person’s illness would be an opportunity for another to make money. The care of human beings should not be a commodity. Since the dawn of time people have done their best to tend to the injured or sick. That’s something very basic to humanity.

Frisch: How do U.S. health outcomes stack up against those in nations with universal healthcare?

Coates: Compared to other developed, wealthy nations, the U.S. comes in last across many indicators of health status. On a worldwide scale, dozens of countries have better health indicators than the U.S. Over the last couple of decades maternal mortality — the preventable death of pregnant women — has gone down in almost every nation on earth, but in the U.S. it has gone up. It’s shocking to think that our country, with so much talk about family values and so much debate about the unborn and so much attention to healthcare, would have worsening maternal mortality.

Frisch: Why is maternal mortality going up here?

Coates: The reasons are myriad, but the most glaring is that the wealthy have gotten super-wealthy, while the poor, who are many times more numerous than the rich, have gotten so much poorer. Women at the bottom aren’t getting proper prenatal care. Some life-threatening conditions that occur during pregnancy, such as eclampsia and gestational diabetes, can be prevented or treated if they are caught early. Too often they aren’t.

Frisch: Aren’t per capita healthcare expenditures in the U.S. also much higher than in other developed countries?

Coates: The U.S., on average, spends twice as much as most other developed nations on healthcare. That’s both per person and as a percentage of gross domestic product. We’re talking about a total of $3 trillion a year, or about ten thousand dollars per person annually. And more than half that money already comes from taxpayer dollars. In effect, we’re paying for national health insurance, but we’re not getting it.

Frisch: Where does all that taxpayer funding go?

Coates: Toward Medicare and Medicaid, health benefits for public employees, and tax credits that help employers pay private insurance companies. Of course taxes also fund veterans’ hospitals, the Indian Health Service, federally funded health centers, and research institutions like the Centers for Disease Control and Prevention and the National Institutes of Health and many other programs. The point is that public spending already allocated should be adequate to meet our full healthcare needs.

Cuba is an interesting comparison. It spends something like a fourth of what the U.S. spends on healthcare per person, but Cuban people have about the same health outcomes as Americans, including life expectancy, infant mortality, and so on. One reason for this is that Cuba has trained so many doctors. In fact, there are more doctors per person in Cuba than anywhere else in the world. And Cuban doctors learn not only to spend more time with their patients but to care for entire communities. What Cuba lacks in monetary resources appears to be compensated for by their many doctors.

Frisch: Could it be that our healthcare outcomes are worse because the pressures of contemporary American life and the food we eat are making us sick?

Coates: There are indeed great pressures. And it’s important for everyone to eat healthy, which is challenging for the poor, who often don’t have access to fresh fruits and vegetables in their neighborhoods. Yet comparative studies have been done, and controlling for the American diet and other lifestyle choices does not explain the inferior health outcomes in the U.S. For example, European nations with longer life expectancies actually have more smokers. In the U.S. we have many more people who live in poverty than European countries do. And we lead the world in incarceration. Poverty and the stress that comes with it have devastating health consequences. With growing income inequality, there’s a case to be made that Americans’ health is becoming worse, mostly for those at the bottom. People work two and three jobs and still can’t make ends meet. Intense social pressure leads to personal disaster. People become more prone to alcoholism and opiate addiction. Domestic violence devastates families. With economic insecurity people find themselves constantly on the move and without a sense of community. Many who are better off are now facing growing insecurity as the middle class disappears. In the hospital I see a stark picture that connects statistics with real human lives.

I’ve written about an uninsured landscaper who didn’t have a steady winter job. He ran a snowblower and drove a plow, but the work was pretty sporadic. When there was a major snowstorm, he tried to work a twenty-hour day, to make up for lost wages. But because he had an infected tooth and had not been able to eat much for a few days, he collapsed after sixteen hours. I ended up admitting him to the hospital.

507 - Kral - Frish - 2
©  Jon Kral

Frisch: Did he survive?

Coates: Yes, he’s OK. I felt a little helpless, because all I could do for his tooth infection was prescribe antibiotics. We see so many social problems at the hospital, which often provides a refuge for people who have no place else to go. It’s distressing and makes me even more determined to fight for a single-payer healthcare system.

Frisch: Why didn’t the U.S. adopt some form of universal healthcare when other countries did?

Coates: The U.S. began to discuss national health insurance around the same time as European nations: in the early twentieth century. At the start of the 1930s a blue-ribbon commission called the Committee on the Costs of Medical Care recommended a system of compulsory insurance and healthcare planning for the whole country. The American Medical Association [AMA] attacked the idea as a communist plot, even though the panel was led by the Republican president of Stanford University, a medical doctor who had also once been the head of the AMA! President Franklin D. Roosevelt, who was inaugurated within weeks of the report’s release, chose to avoid the matter.

When World War II came along in the 1940s, the country entered an enormous industrial boom, and the government imposed a wage freeze to help the war effort. Looking to attract workers, employers offered healthcare benefits instead of higher wages. By the end of the war, employer-sponsored private health insurance was entrenched. After the war, in the United Kingdom, the Labour Party established the National Health Service, guaranteeing necessary medical care to everyone. As the troops came home in the U.S., the government expanded benefits and guaranteed healthcare for veterans, and President Harry Truman began to champion the idea of national health insurance. In response the AMA hired a Madison Avenue advertising firm to counter Truman’s initiative. They came up with the term “socialized medicine” to defeat Truman’s agenda, again disparaging the idea as a communist plot.

Frisch: Did the AMA represent the way most physicians felt?

Coates: That’s a good question. Probably not. I think the AMA was dominated by the most money-conscious members of the profession, who feared national healthcare would mean lower pay for the wealthiest doctors.

Frisch: One of the arguments against single-payer is that it can cause long waits for treatment. How do waits under Canada’s single-payer system compare with what we face in the U.S. today?

Coates: Let me tell you a story. I see many low-income patients. For example, a man may have a meniscus tear — a chronic knee injury that can be repaired with arthroscopic surgery — but he has no insurance. The elective surgery would require an exorbitant cash payment. His wait time for arthroscopic surgery is effectively infinite — or, at least, until he gets insurance that covers it. But no one is tracking those kinds of wait times in our country.

It’s true that, in Canada, wait times for elective surgeries — especially orthopedic surgeries — have sometimes been frustratingly long. A Canadian who needs arthroscopic surgery might not get into the operating room for many weeks. This has provoked public outrage in Canada, because it’s seen as a disgrace to the nation, as it should be. As a result of all this hue and cry, wait times for elective procedures are improving there. And I should emphasize that we’re talking about elective, not emergency, interventions.

Can we compare wait times in Canada and the U.S. if we don’t keep records on wait times here, while the Canadian data is public? Wait times are an ideological talking point used by people who want to privatize even more of the healthcare system.

Frisch: Are you satisfied with the sort of care people get in the U.S. when they do go to the doctor?

Coates: No. In my experience it’s too often undignified. Countless patients have been refused care or misdiagnosed or given inappropriate prescriptions. We recently discharged a man from the hospital to home hospice because he had a terminal brain tumor. During the discharge meeting, his daughter and son told us how over the previous year his insurer had refused to pay for a scan of his brain, even though his cardiologist and his primary-care physician had ordered it. The man ended up in the hospital, where the emergency-room doctor ordered a CT scan and found the brain tumor within an hour. His children were left to wonder whether their father’s life could have been extended if the insurance company had allowed the test a year earlier.

This patient had a type of Medicare called Medicare Advantage: a program through which private insurers are paid to administer Medicare benefits. Medicare Advantage plans may offer frills like a gym membership to attract patients, but in return the insurers are allowed to chisel away important benefits, things that traditional Medicare would cover without question. This is what you get when you privatize Medicare.

These days, in almost every case, there’s some way in which profiteering intervenes. I discharged a woman with a prescription for a medication that was decades old and generic. It turned out that a big pharmaceutical company had recently cornered the market on it, and a medication that a few years ago cost pennies per pill now costs more than a thousand dollars a month. She couldn’t afford it, because her insurance required her to pay a percentage of the cost of each prescription.

Sometimes an ambulance ride is not covered. I once had a clinic patient who needed to be in the hospital, but she refused to take an ambulance after having previously been billed a large amount for one. So I drove her forty miles myself. Some of my colleagues were shocked to hear this, asking, “What if something had happened while she was in your car?”

Or take hepatitis C. Medications can now cure hepatitis C. So what’s the holdup? The pharmaceutical companies charge tens of thousands of dollars for these medications. Doctors have been fighting with state Medicaid agencies to cover these drugs, but the sky-high retail price remains an obstacle.

Frisch: Are most physicians upset about the things you’ve described?

Coates: I think there’s enormous moral distress within the profession. Physicians don’t feel able to live up to their calling. They don’t have good job satisfaction. They want to spend more time with patients.

Frisch: Senator Claire McCaskill claims this isn’t a good time for the U.S. to transition to single-payer, because we’re already having trouble paying for all the baby boomers going on Medicare.

Coates: Warnings that the Medicare trust fund is going bankrupt come and go despite the fact that the system basically works. Politicians have the nerve to talk about the impending bankruptcy of Medicare when out-of-pocket spending on healthcare is bankrupting families right now. The best way to save Medicare would be to expand it to include everyone. The real reason the powerful are so opposed to single-payer is not because it won’t work but because it will.

When Canada enacted its Medicare system in the early 1970s, Canada and the U.S. were tracking even in terms of per capita healthcare costs. Today Canada is spending half of what the U.S. spends and getting better outcomes, better access to care, and better quality of life. This shows that a single-payer model absolutely will work if the goal is to cover everyone and save costs. It won’t work if the goal is to protect the interests of private insurers. It won’t work if the goal is to maximize profits.

Frisch: I’ve noticed there are no longer any independent medical practices in my county. Now they’re all under the umbrella of a single hospital.

Coates: The advent of most physicians becoming employees within a large corporate structure is something the medical profession hasn’t really come to terms with. Physicians continue to have the small-shopkeeper mentality, and we do retain a great deal of professional autonomy. But now, as employees in vast systems, we have begun to lose say over many aspects of care.

Frisch: Some opponents of healthcare reform have proposed that patients should shop around by cost for tests, drugs, and hospital stays.

Coates: With healthcare there’s no way to be a fully informed consumer, because you can’t know precisely what your future needs will be. If you develop the worst headache of your life and are in excruciating pain, you can’t know whether you’re having a migraine or a brain hemorrhage. You might need ibuprofen, or you might need a neurosurgeon. The idea of going shopping during a possible intracranial hemorrhage is just silly. The only solution that makes sense is having a healthcare infrastructure at the ready when we need it.

Frisch: How should individual physicians be paid for seeing patients?

Coates: Personally I think the full-time-salary model is the most honorable, but that may not be for everyone. There’s no perfect way to pay doctors. If you pay them a fee for service, it may encourage some to provide unnecessary services. If you pay them by the hour, it may encourage some to work too many hours. If you pay them a salary, it may encourage some to go home early. The best system would be to assume that doctors are doing the best they can for patients and let them organize themselves to decide how they want to be paid.

Frisch: Uninsured people tend to be charged more for healthcare than people who are insured. Overall who pays more under the present system: the insured or the uninsured?

Coates: The uninsured pay with their lives. For every million people without health insurance in the U.S., about a thousand deaths occur that could have been prevented. But the costs of a catastrophic illness are unpredictable even for those with insurance. I met a colleague, a senior physician, in the supermarket the other day. She told me that she had taken early retirement. I was about to congratulate her when she explained that her granddaughter had been hit by an automobile and her daughter had been fired for missing too much work, because she had to be at the hospital. The daughter was able to regain employment, but the care needs of my colleague’s granddaughter remained so significant that my colleague was taking early retirement to be there for her family. How can we measure the cost of that to society?

Studies show that the burden of providing care near the end of life falls disproportionately on women family members. The costs are great: not just financially but also to the health of the caregiver. Data also show that if your spouse dies, you have a higher likelihood of dying soon after. This often has to do with the stress of providing care: the lost sleep, the lost resources, and, many times, the lost jobs. Who pays? We all do.

Frisch: Many people don’t have the option to provide care when family members need it.

Coates: I have patients who are hospitalized but can’t afford to miss work. They fear being fired, or they simply can’t do without the income. I’ve written letters to their employers in hopes of helping them negotiate a little more time for recovery.

Frisch: Is it legal to fire people because they’re sick?

Coates: They’re not fired because they’re sick. They are fired because they’re not at work. It’s cruel.

Frisch: Is it different in other countries?

Coates: Absolutely. Other countries have not only sick-leave protections but also maternity and paternity leave.

Frisch: Let me see if I understand the basics of the system you’re pushing for: The government would provide free healthcare for everyone, paid for by taxes. You would not have to enroll; you would just have it. And I assume you’d be able to choose your physician.

Coates: Right. Physicians who participated in the system would be forbidden from having a private practice on the side, outside of the system. Doctors who wanted to have a private, for-cash practice could conceivably do so. But with the entire population covered by public healthcare, that would make little sense. With almost all doctors taking part in the system, patients could choose from a wide selection of providers. This kind of competition for the best-quality providers might turn out to be healthy for all of us.

The role of the government in this system would be to pay the costs and protect the patient-provider relationship. Medical decisions should be made privately — by the patient and the doctor — and the government should respect whatever decision they make, providing that decision is within the realm of medical science.

If we all pay a small percentage of our income into the system, we can ensure that everyone gets care. Sure, some of us, disabled by illness, will not be able to pay. But the rest of us should proudly contribute, with the understanding that we are building a system that protects us all.

Frisch: Would there be limits on allowable treatments for a given condition?

Coates: If a physician is proposing treatments that lack any credible evidence, then those treatments won’t be funded. On the other hand, if a treatment is supported by the medical evidence — and the patient and physician believe it’s worth a try — then that should be the patient’s personal decision.

Frisch: What are the chances that the system you envision will be enacted here?

Coates: I think the profound contradictions of the current system make it more likely: We have the contradiction that healthcare is so essential and yet so undignified in its delivery, with money always the underlying issue. Then there’s the contradiction that we’re paying so much more for healthcare compared with other nations but getting such inferior results. So everyone involved in the system gets progressively more frustrated and ground down. Yet we all know it doesn’t have to be this way.

I’m optimistic. Of all the social reforms that could transform the country, single-payer seems to me the most likely to happen. Still, we don’t have a mass movement of millions of people pushing for this, and that is what it will take.

Reverse the Cuts to Canada Post – Restore and Expand Door-to-Door
worker | February 23, 2018 | 7:40 pm | Canada, Communist Party Canada | Comments closed

February 22, 2018

http://communist-party.ca/statement/2727

The Communist Party of Canada demands that the Liberal government live up to their promises made during the Federal election surrounding Canada Post and immediately restore door-to-door delivery service for the nearly one million households who have had this service cut.

Part of the Harper government’s legacy of attempts to privatize the postal service, bust the Canadian Union of Postal Workers (CUPW) and attack workers’ wages, pensions and working conditions, was cutting the door-to-door mail delivery to 800,000 people and the installation of “mega-box” mail delivery. After CUPW and allies, including the Communist Party, fought against this bid to reduce service as part of the broader privatization agenda, Justin Trudeau promised to reverse the cuts during the 2015 Federal election.

After a lengthy review and delays by the Trudeau government, the federal government released a report in late January of this year announcing that previous plans to cut door-to-door delivery to an additional four million households would be canceled. This has demonstrated once again that mass, independent political action on the part of the labour movement can be effective in fighting back and winning jobs for their members and strengthened public services for all.

The government’s refusal to reverse the already implemented cuts and the further delay in forwarding decisions about the direction of Canada Post to the crown corporation’s board of directors, shows that the fight is far from over. In fact, many addresses, especially in rural areas, never had door-to-door service to begin with and are sorely in need of an expansion of delivery services.

The Communist Party of Canada continues to stand in solidarity with postal workers and supports CUPW’s demands to implement an expansion to the public post office to address climate change, and maintaining the service’s financial self-sufficiency with expanded public services including postal banking. Postal banking in particular would expand banking and financial services to communities left high and dry by the monopoly banks who have raked in record profits while closing branches and charging higher and higher fees. Many countries operate publicly owned postal banks, as did Canada until 1969.

Furthermore, the Communist Party of Canada calls on the Federal government and Canada Post to negotiate in good faith with postal workers in upcoming bargaining this year and break with the recent history of attacks on workers and their union.

Special resolution of the Central Committee, Communist Party of Canada, Feb 11th, 2018

‘For the Motherland’: Red Army on Soviet Posters
worker | February 22, 2018 | 7:18 pm | Red Army, USSR | 1 Comment

https://sputniknews.com/photo/201802221061891541-poster-red-army/

  • For Motherland: Red Army on Soviet Posters

 

20:17 22.02.2018Get short URL
© Sputnik/ Pavel Balabanov
“Who we beat” by N. Dolgorukov and V. Deni, 1939.

As the national Defender of the Fatherland Day has wives and girlfriends shopping for small gifts all over Russia, we look back at how Soviet propaganda glorified the military visually.

First celebrated in 1919, the holiday marks the date a year prior during the Civil War, when the Red Army conducted its first mass draft in Moscow and St. Petersburg (known as Petrograd back then).

Originally known as Red Army Day, it was renamed to Soviet Army and Navy Day in 1949, and finally was given its current title by Vladimir Putin in 2002.

Engels On the Importance of the Theoretical Struggle
worker | February 21, 2018 | 9:24 pm | V.I. Lenin | Comments closed

From What Is To Be Done? by V. I. Lenin

https://www.marxists.org/archive/lenin/works/1901/witbd/i.htm

D. Engels On the Importance of the Theoretical Struggle

“Dogmatism, doctrinairism”, “ossification of the party – the inevitable retribution that follows the violent strait-lacing of thought” – these are the enemies against which the knightly champions of “freedom of criticism” in Rabocheye Dyelo rise up in arms. We are very glad that this question has been placed on the order of the day and we would only propose to add to it one other:

And who are the judges?

We have before us two publishers’ announcements. One, “The Programme of the Periodical Organ of the Union of Russian Social Democrats Abroad – Rabocheye Dyelo” (reprint from No. 1 of Rabocheye Dyelo), and the other, the “Announcement of the Resumption of the Publications of the Emancipation of Labour Group”. Both are dated 1899, when the “crisis of Marxism” had long been under discussion. And what do we find? We would seek in vain in the first announcement for any reference to this phenomenon, or a definite statement of the position the new organ intends to adopt on this question. Not a word is said about theoretical work and the urgent tasks that now confront it, either in this programme or in the supplements to it that were adopted by the Third Congress of the Union Abroad in 1901 (Two Conferences, pp. 15-18). During this entire time the Editorial Board of Rabocheye Dyelo ignored theoretical questions, in spite of the fact that these were questions that disturbed the minds of all Social-Democrats the world over.

The other announcement, on the contrary, points first of all to the declining interest in theory in recent years, imperatively demands “vigilant attention to the theoretical aspect of the revolutionary movement of the proletariat”, and calls for “ruthless criticism of the Bernsteinian and other anti-revolutionary tendencies” in our movement. The issues of Zarya to date show how this programme has been carried out.

Thus, we see that high-sounding phrases against the ossification of thought, etc., conceal unconcern and helplessness with regard to the development of theoretical thought. The case of the Russian Social-Democrats manifestly illustrates the general European phenomenon (long ago noted also by the German Marxists) that the much vaunted freedom of criticism does not imply substitution of one theory for another, but freedom from all integral and pondered theory; it implies eclecticism and lack of principle. Those who have the slightest acquaintance with the actual state of our movement cannot but see that the wide spread of Marxism was accompanied by a certain lowering of the theoretical level. Quite a number of people with very little, and even a total lack of theoretical training joined the movement because of its practical significance and its practical successes. We can judge from that how tactless Rabocheye Dyelo is when, with an air of triumph, it quotes Marx’s statement: “Every step of real movement is more important than a dozen programmes.”[21] To repeat these words in a period of theoretical disorder is like wishing mourners at a funeral many happy returns of the day. Moreover, these words of Marx are taken from his letter on the Gotha Programme,[22] in which he sharply condemns eclecticism in the formulation of principles. If you must unite, Marx wrote to the party leaders, then enter into agreements to satisfy the practical aims of the movement, but do not allow any bargaining over principles, do not make theoretical “concessions”. This was Marx’s idea, and yet there are people among us who seek-in his name to belittle the significance of theory!

Without revolutionary theory there can be no revolutionary movement. This idea cannot be insisted upon too strongly at a time when the fashionable preaching of opportunism goes hand in hand with an infatuation for the narrowest forms of practical activity. Yet, for Russian Social-Democrats the importance of theory is enhanced by three other circumstances, which are often forgotten: first, by the fact that our Party is only in process of formation, its features are only just becoming defined, and it has as yet far from settled accounts with the other trends of revolutionary thought that threaten to divert the movement from the correct path. On the contrary, precisely the very recent past was marked by a revival of non-Social-Democratic revolutionary trends (an eventuation regarding which Axelrod long ago warned the Economists). Under these circumstances, what at first sight appears to be an “unimportant” error may lead to most deplorable consequences, and only short-sighted people can consider factional disputes and a strict differentiation between shades of opinion inopportune or superfluous. The fate of Russian Social-Democracy for very many years to come may depend on the strengthening of one or the other “shade”.

Secondly, the Social-Democratic movement is in its very essence an international movement. This means, not only that we must combat national chauvinism, but that an incipient movement in a young country can be successful only if it makes use of the experiences of other countries. In order to make use of these experiences it is not enough merely to be acquainted with them, or simply to copy out the latest resolutions. What is required is the ability to treat these experiences critically and to test them independently. He who realises how enormously the modern working-class movement has grown and branched out will understand what a reserve of theoretical forces and political (as well as revolutionary) experience is required to carry out this task.

Thirdly, the national tasks of Russian Social-Democracy are such as have never confronted any other socialist party in the world. We shall have occasion further on to deal with the political and organisational duties which the task of emancipating the whole people from the yoke of autocracy imposes upon us. At this point, we wish to state only that the role of vanguard fighter can be fulfilled only by a party that is guided by the most advanced theory. To have a concrete understanding of what this means, let the reader recall such predecessors of Russian Social Democracy as Herzen, Belinsky, Chernyshevsky, and the brilliant galaxy of revolutionaries of the seventies; let him ponder over the world significance which Russian literature is now acquiring; let him. . . but be that enough!

Let us quote what Engels said in 1874 concerning the significance of theory in the Social-Democratic movement. Engels recognizes, not two forms of the great struggle of Social Democracy (political and economic), as is the fashion among us, but three, placing the theoretical struggle on a par with the first two. His recommendations to the German working-class movement, which had become strong, practically and politically, are so instructive from the standpoint of present-day problems and controversies, that we hope the reader will not be vexed with us for quoting a long passage from his prefatory note to Der deutsche Bauernkrieg,[11] which has long become a great bibliographical rarity:

“The German workers have two important advantages over those of the rest of Europe. First, they belong to the most theoretical people of Europe; and they have retained that sense of theory which the so-called ’educated’ classes of Germany have almost completely lost. Without German philosophy, which preceded it, particularly that of Hegel, German scientific socialism – the only scientific socialism that has ever existed – would never have come into being. Without a sense of theory among the workers, this scientific socialism would never have entered their flesh and blood as much as is the case. What an immeasurable advantage this is may be seen, on the one hand, from the indifference towards all theory, which is one of the main reasons why the English working-class movement crawls along so slowly in spite of the splendid organisation of the individual unions; on the other hand, from the mischief and confusion wrought by Proudhonism, in its original form, among the French and Belgians, and, in the form further caricatured by Bakunin, among the Spaniards and Italians.

“The second advantage is that, chronologically speaking, the Germans were about the last to come into the workers’ movement. Just as German theoretical socialism will never forget that it rests on the shoulders of Saint-Simon, Fourier, and Owen – three men who, in spite of all their fantastic notions and all their utopianism, have their place among the most eminent thinkers of all times, and whose genius anticipated innumerable things, the correctness of which is now being scientifically proved by us – so the practical workers’ movement in Germany ought never to forget that it has developed on the shoulders of the English and French movements, that it was able simply to utilise their dearly bought experience, and could now avoid their mistakes, which in their time were mostly unavoidable. Without the precedent of the English trade unions and French workers’ political struggles, without the gigantic impulse given especially by the Paris Commune, where would we be now?

“It must be said to the credit of the German workers that they have exploited the advantages of their situation with rare understanding. For the first time since a workers’ movement has existed, the struggle is being conducted pursuant to its three sides – the. theoretical, the political, and the practical-economic (resistance to the capitalists) – in harmony and in its interconnections, and in a systematic way. It is precisely in this, as it were, concentric attack, that the strength and invincibility of the German movement lies.

“Due to this advantageous situation, on the one hand, and to the insular peculiarities of the English and the forcible suppression of the French movement, on the other, the German workers have for the moment been placed in the vanguard of the proletarian struggle. How long events will allow them to occupy this post of honour cannot be foretold. But let us hope that as long as they occupy it, they will fill it fittingly. This demands redoubled efforts in every field of struggle and agitation. In particular, it will be the duty of the leaders to gain an ever clearer insight into all theoretical questions, to free themselves more and more from the influence of traditional phrases inherited from the old world outlook, and constantly to keep in mind that socialism, since it has become a science, demands that it be pursued as a science, i.e., that it be studied. The task will be to spread with increased zeal among the masses of the workers the ever more clarified understanding thus acquired, to knit together ever more firmly the organisation both of the party and of the trade unions….

“If the German workers progress in this way, they will not. be marching exactly at the head of the movement – it is not at all in the interest of this movement that the workers of any particular country should march at its head – but they will occupy an honourable place in the battle line; and they will stand armed for battle when either unexpectedly grave trials or momentous events demand of them increased courage, increased determination and energy.”[23]

Engels’s words proved prophetic. Within a few years the German workers were subjected to unexpectedly grave trials in the form of the Exceptional Law Against the Socialists. And they met those trials armed for battle and succeeded in emerging from them victorious.

The Russian proletariat will have to undergo trials immeasurably graver; it will have to fight a monster compared with which an antisocialist law in a constitutional country seems but a dwarf. History has now confronted us with an immediate task which is the most revolutionary of all the immediate tasks confronting the proletariat of any country. The fulfilment of this task, the destruction of the most powerful bulwark, not only of European, but (it may now be said) of Asiatic reaction, would make the Russian proletariat the vanguard of the international revolutionary proletariat. And we have the right to count upon acquiring this honourable title, already earned by our predecessors, the revolutionaries of the seventies, if we succeed in inspiring our movement, which is a thousand times broader and deeper, with the same devoted determination and vigour.