Shands makes a deal with enemy of health reform

May 11, 2009

Hospital closing will benefit promoter of cash-register medicine.

As part of closing Shands at AGH, Shands has made a deal with Solantic, a private, for-profit corporation, to open an urgent care center in Ayers Medical Plaza (720 SW 2nd Ave.) right across the street from what is now a busy hospital but in October is slated to become an empty hulk.

Shands claims it has capacity to handle the extra emergency room cases at its Shands at UF facilities on Archer Road. When asked if Shands at UF had the ability to handle the approximately 700 births at AGH every year, Shands CEO Tim Golfarb told the Gainesville Sun “There is capacity, but it will be tight.”

About 17,000 of the 73,000 emergency room cases AGH and Shands at UF see annually could be cared for in an urgent care center, Goldfarb told the Gainesville Sun. But there are already several urgent care centers in Gainesville, including one run by Solantic at NW 39th Ave. near 43rd St. Emergency room patients have already decided they need to go to an ER. So it is unclear whether Goldfarb expects these patients to self-diagnose and sort themselves out, or whether Shands will be sending the new influx of emergency room patients to the new urgent care center.

Assuming those patients can afford it, that is. After negotiations with Shands, Solantic agreed to take Medicaid patients (big of them, considering they can bill the government, which is easier to deal with than private insurance), but all others must pay up front for services or provide proof of insurance coverage. As Goldfarb told the Sun in a May 9 article, Solantic “Is used to true retail business,” and “in fact they post charges right on the wall of the waiting area.” Because as we all know, if you’ve smashed a finger, it’s nice to know what it’ll cost you to have it set, that way while you’re waiting you can decide whether you really need it or not.

Adding insult to injury, the chair of the Solantic chain is Richard L. Scott, the disgraced former CEO of Columbia/HCA. Under Scott’s leadership, Columbia/HCA bought up so many hospitals it became the largest hospital chain in the U.S. Also under his leadership, Columbia/HCA was found guilty of the largest Medicare fraud in history and fined $1.7 billion dollars. Scott was not charged criminally, but the board of directors relieved him of his duties after the fiasco was revealed.

It would perhaps be enough to give us pause that Scott oversaw Columbia/HCA while it was defrauding the government and that his new company is now benefiting from hospital closures like Shands’ closure of AGH. But Scott is also a major opponent of health care reform, and has ponied up $5 million to launch a group, Conservatives for Patients Rights, which promotes for-profit medicine and maligns national health care systems in which health care is regarded as a right. The group denounces any attempts to pass health care reform from the Obama plan to more thorough plans like HR 676. (Check out CPR’s website at

Running a chain of urgent care centers in this economic climate can’t be easy. Health care is expensive and a lot of people are losing their jobs and insurance and can’t afford it. Others have insurance that won’t pay, or carry high deductibles. Around 17 percent of us have no insurance at all. So an urgent care center might have quite a few customers (uh, patients) who can’t pay.

But as it turns out, Solantic might consider providing care to these people, as long as it can get its hands on some public money. The money it has its eye on in Gainesville is that collected by Alachua County’s CHOICES to provide some coverage those who work but can’t afford insurance.

So Richard Scott, enemy of health care reform, wants money that came from Alachua County’s small CHOICES health care reform effort, to ensure profits at this private urgent care center. All the while he’s spending profits from his medical enterprises to denounce any expansion of the public safety net, and trying to make people think national health insurance would be a nightmare.

Yes, that might seem contradictory. But the real reason characters like Scott attack anything provided in the public sector is that every time a public program is starved or destroyed it opens up opportunities for the private sector to suck more money out of our wallets. The less we have guaranteed in the public sector the more we will be forced to purchase in the private sector, and the more profits Scott and his ilk can extract from us. The fact that some number of people will not be able to access health care at all just serves as a threat to everyone else to keep working harder in a never-ending race to buy health security. But health care should be a birthright, as it is in many other countries.

Shands currently has an average 5-hour wait in the emergency room. One reason is that a lot of people can’t access care any other way. Another is that emergency room staff are spread thin and overworked. The Richard Scotts of the world benefit from our overburdened system when patients show up at his urgent care centers, trying to avoid these long waits.

Solantic claims it’s saving people money because they can get care cheaper at an urgent care center than they can at an emergency room. That may be true for particular minor injuries, but as hospitals close and minor injury clinics are substituted, we will pay a much greater price as the community loses the beds and facilities necessary for coping with real emergencies.

Unlike AGH, Solantic has no mandate to provide care if you can’t pay, so it can be ‘profitable’ by cherrypicking ‘profitable’ customers with easy, lucrative problems and leave the ‘inefficient’ public sector to provide care to the ‘unprofitable,’ the uninsured and the serious, complicated emergency cases.
Shands and Alachua County should tell Richard Scott and his for-profit clinic to take a hike. Instead of subsidizing his profits, we should continue to spend our limited public money to support already-existing entities, for example the Health Department and the Shands Eastside clinic. That way we won’t be subsidizing Solantic’s profits, and we won’t be paying to have lies about health care reform shoved down our throats by its chairman.

As for Shands’ closure of AGH, Goldfarb told a meeting of the Alachua County Medical Society that Shands spends $116 million in “charity” care a year, according to Dr. Caroline Rains, head of the ACMS. So that makes the $12 million that Shands estimates it loses every year from AGH seem like a small slice of the overall pie.

Everyone (except perhaps Richard Scott) agrees that the problem is not that we don’t have enough people who need medical care, the problem is too few paying customers, a problem that could be solved if the U.S. adopted a national health insurance system like most other industrialized countries. That way the 30% of each health care dollar currently diverted to private insurance companies’ profit, paperwork and bureaucracy could go to health care and health care providers. Instead of losing hospitals (where care is provided) we’d see insurance company offices (where care is denied) closing up.

Goldfarb didn’t show up on May 5 for a long-planned public meeting of the County Commission to discuss the closing of the hospital. His absence angered county commissioners, who had been expecting to have a dialog. In a private meeting with Gainesville Sun editors on May 8 he said “the barn door is closed as far as the hospital is concerned.”
(Printed in the Gainesville Iguana, May/June 2009. Thanks to Jack Price for alerting us to this story.)


Instead of pay, we got loans and credit cards

November 25, 2008

(An editorial the local paper wouldn’t print.)

The mainstream media says the cause of the economic crisis is that people can’t pay their home mortgages, with the implication that the crisis is their fault. But the basic reason for this crash, the worst since 1929, is that working people in the U.S. haven’t seen a real rise in wages since the 1960’s.

Meanwhile, everything from housing to healthcare to college has risen out of sight—much of it ignored by the official inflation rate. Families have coped by both spouses working where one used to before. We borrowed to go to school. We borrowed to buy a car. We borrowed to pay our health care bills. Many of us borrowed against our houses, because the value of housing seemed to be going ever upward. So, we were told, you can always refinance and get a lower rate.

When the housing bubble burst and prices began to go down, we could no longer refinance. And when the usurious interest rates on adjustable rate mortgages jumped, we couldn’t pay those either. Surprise! The banks were dependent on us, not the other way around.

But the basic question is, why are we not paid enough on the job to obtain the requirements of life without incurring huge debt? A big part of it is that the labor movement has been hemmed in and destroyed by employer hostility and anti-worker laws. Unions—the main mechanism that allows workers to get decent pay and benefits for their work—only represent 12% of workers now, down from 35% in the 1950s. When the union movement was strong, everyone’s wages were higher because employers knew their workers could leave and get better pay elsewhere.

This suppression of unions was so successful that our employers, especially the big corporations, were rolling in cash—money they no longer had to pay in wages—and they had to find a place to lend it. I once got an offer from a mortgage company to lend me $30,000 on a falling-down shed I own. It’s worth about $2,000, generously. These companies were desperate to loan us money. But lots of cash at the top leads to a bubble economy.

The real economy is not based on complex derivatives and investment vehicles, the economy is us, working people who make things go. If we’re not paid enough to buy what we need, the system will eventually grind to a halt. Pushing credit cards and home equity loans instead of a decent paycheck only works as long as we can make payments, and there are now enough people who can’t make payments—perhaps as many as 6 million families who may face foreclosure—to make the banks freeze up.

It’s good news that the government is stepping in to buy up parts of the banks—that might help the acute, “heart-attack” phase of the disaster. But the longer-term solution must include paying working people the wages we need for a decent living. That means passing pro-worker laws like the Employee Free Choice Act so we can get more power on the job and negotiate higher wages. On top of that, our government should keep some of those banks in the public sector, so when we do borrow money, it’s not from a profit-making corporations with lying advertisements and punishing interest rates. The rest should be regulated like utilities—for the good of all.

And the leading cause of personal bankruptcy is health care bills—so we need a health care system that is publicly financed and universal, like Medicare only starting at age zero. Other advanced countries do that and get more care per dollar and better life expectancies than we have here.

Anyone at risk of losing their only home needs the chance to negotiate a workable payment. People complain “Why should someone else get a break when I made my payments on time?” But foreclosures are bad for everyone, not just the family struggling to make payments. They destroy neighborhoods and further drive down the cost of housing. And anyone could get laid off—and lots will in this “recession”—there needs to be a real safety net with unemployment insurance that doesn’t run out.

The looting of the banks has already occurred through years of big payments and bonuses to already fabulously wealthy owners and managers. Rather than rescuing the rich, who don’t need rescuing, let’s get some of that stolen wealth back by taxing the rich and raising wages, to increase the working class’s share of our national wealth. No more bubble economy, let’s build working-class power instead.

Jenny Brown is co-chair of the Alachua County Labor Party in Gainesville, Florida.

Economic meltdown

October 15, 2008

What a difference two weeks makes!

In late September, Republicans in Congress were laughing with scorn at the Democrats for suggesting that the U.S. government should buy stakes in the banks to forestall an economic meltdown. This strategy was derided as “too European” and interventionist.

Now Federal Reserve Chair Ben Bernanke, with pressure from foreign powers, is dragging Treasury Secretary Henry Paulson into doing just that. Why? Right now banks won’t lend money to each other, or to anyone else. They’re too scared they won’t get the principal back–they fear any bank might turn out to be a rotten shell. The resulting “credit freeze” and has the effect of bringing important economic activity to a screeching halt. Forecasting a looming disaster, the stock market has become bipolar and skittish.

The panic has meant that even conservatives are willing to cede some control of private enterprises to the government, at least for the moment.

Those of us disgusted with the system should ask, why not nationalize the banks permanently? They could be operated in the public interest, like the post office or the library, charging low interest for loans, paying their managers decent but not crazy salaries, but most importantly, not driven to make a profit no matter the cost. It turns out that would not be that expensive given that we’re having to shore them up when they are periodically looted by their owners.

This issue of the Iguana we direct you to several articles related to the economic crisis. We hope they will be more clarifying than recent news reports.

How did we get to this point?

We got to this point because, in the words of United Mine Workers union leader Cecil Roberts, “Too few people have too much money.” Inequality in the U.S. is approaching that of 1900. Indeed, economist Doug Henwood compares our period to the Gilded Age in a very clarifying short article in the Nation: . The richest 1% in the U.S. have more wealth than the bottom 95%. This punishing disparity didn’t come about without struggle. It is the result of sustained top-down class warfare, notably advanced under Carter when then-Federal Reserve chair Paul Volcker moved to create unemployment by pushing the federal funds rate up. This created a recession we know now as the “Reagan recession.” Eleven percent unemployment drove wages down, and they’ve been smothered ever since by a combination of slashed safety-nets and union-busting.

The right would like to blame the economic crisis on people of modest means who borrowed money to buy a house but couldn’t pay it back. But why are our wages so low (and employment so insecure) that we can’t afford housing? Why are we going deeper into debt to pay everyday bills? Why do 20% of U.S. households have zero or negative net worth? All of these things can be attributed to the decline in real wages in the U.S. Our wages peaked in the late 1960’s and have been falling since then, despite the fact that our productivity has risen more than 50% in the same period. Laws unfriendly to unions mean that we haven’t been able to bargain higher wages. So even though we’ve been very productive, our pay has not reflected the wealth we’ve created.

As an underpaid workforce, we’ve turned to borrowing to buy the things we need (housing, health care, higher education, lately even food and fuel). We’ve been using credit cards, taking out student loans, and borrowing against our homes (because their value was supposed to be going up, that seemed OK). But workers’ share of the money in the U.S. is not big enough to sustain our debt, never mind pay the interest rates that mortgage companies charged when low-interest mortgages reset to higher-interest mortgages. When we reached the breaking point, as millions of families did in the last two years, the banks that relied on our regular payments broke down too. Financial instruments which exaggerate both gains and losses have amplified the effect, but the basic problem remains that we are not paid enough to buy the products of our labor. Extending us credit could only hide the problem for so long. For a much deeper and extensive analysis of the crisis, see Sam Gindin and Leo Panitch’s article on Znet: “The Current Crisis, A Socialist Perspective,” at:

Where did the money go?
The employing class, rolling in cash due to our low pay, have been happy to lend us money, since they can get a return on it. Much better than paying it to us in wages! They’ve been investing in financial markets, including complicated insurance schemes which they expected would protect their investments while providing wild returns. All the money sloshing around tamed regulators and in many cases meant lobbyists could extract laxer laws from a pliant Congress. With the repeal of regulation came more and more fictional accounting which allowed firms to richly compensate their high-flying CEOs and owners. Like Enron, these firms looked profitable. Why not reward that? So the money went to make the very rich personally very richer–resulting in a new gilded age of $37 million apartments, $3 million birthday parties, $480,000 watches and $300,000 outfits, like that worn by Cindy McCain at the Republican convention. The rich have not been taxed much (certainly not nearly as much as they were in past eras), so instead an underfunded government has borrowed money from them, creating another source of financial wealth.

When banks and insurance companies started to fail, the “$700 billion bailout” was an attempt to inject ready cash from the U.S. Treasury into the remaining banks so they wouldn’t also go belly-up and bring the economy down with them. But people ask, where did the money go? Much of the money was already spent. Another great portion of it was imaginary, in that it relied on inflated expectations rather than goods in the real economy. Now it looks like the promise of $700 billion to buy bad assets isn’t enough to make private banks lend money to each other. Both sides of the aisle now agree that the government needs to buy them, or significant portions of them, to induce them to fulfill their lending role. More on the seriousness of the crisis can be found in an interview with the Monthly Review’s John Bellamy Foster, at

How will all this affect everyday people?
The recession has hit us first. Indeed, the last recession, the one that started with Bush’s first term, never really left if you look at our wages. Now we’re feeling the effects as millions face foreclosure and eviction or bankruptcy from unemployment and health care bills. The prices of food and fuel have nearly doubled in the last 3 years, whittling our savings down to nothing. And retirement funds linked to the stock market have lost 20% of their value over the past year (not counting recent market flailing), meaning many people who hoped to retire soon don’t dare. When people put off retirement, that makes jobs scarcer, and the general slowdown will amplify unemployment.

It is not an exaggeration to say that capitalism could bring us another Great Depression. (Some felt the Bush administration was crying wolf to shove through the bailout, but it may well turn out that the Administration was too slow to take action when banks started to fail, not too hasty.) But more likely is a long, miserable recession. Neither scenario automatically means our living standards must be further destroyed, however. Progressive measures that were unthinkable a year ago sound reasonable today, and we should push our advantage while the wage-slashers, union-busters and credit-pushers are in disarray.

Union folks, progressives and people who care about justice can (indeed, for our own survival, must) demand a major rearrangement of the priorities of our government. These should be aimed at blunting the blow of economic the downturn and increasing workers’ share of the national wealth. After all, it’s the gap between the rich and the rest of us that’s largely responsible for bringing our economy to a standstill.

Here are a few ideas:
–stop evictions; moratorium on foreclosures
–guarantee unemployment benefits that don’t run out
–raise the minimum wage to 1968 levels ($9.50 in 2007 dollars)
–make it easier to form and join a union (the Employee Free Choice Act would be a start).
–tax the rich and corporations as way of recovering some of the recent loot
–institute national health insurance for everyone–health care costs are the leading cause of family bankruptcy
–rewrite bankruptcy laws to work for everyday people not credit card companies
–rebuild and repair our infrastructure, putting people to work in good public jobs
–dedicate public funds to sustainable alternative energy with low carbon output
–build and fund public housing and cooperative housing instead of promoting expensive mortgages and “home-ownership” as a way to wealth.

What about the elections?
Barack Obama and the Democrats have cautiously supported some of these measures some of the time. Much of this support has been half-assed or absent when it mattered. And it’s true that the crisis has been a bipartisan creation, long in the making. However, if we want a legislature and executive branch we can push, a big mandate for an Obama administration and a large Democratic majority in both houses of Congress will give us a fighting chance. A Democratic victory would also allow us to see that Democrats are not enough, we need an explosively growing grassroots movement of working people of all colors to force our leaders to confront this crisis. Under Republicans, we’ll continue to be fed the line that we just need Democrats in power, and the Democrats will continue rightward.

What can we expect under a McCain-Palin administration, with its half-baked, pro-rich economic platform and profoundly militarist “us against the world” ideas? We’re getting a taste of where they’re going when we witness their appeals to white voters on the basis of racism and fear-mongering. At McCain and Palin rallies, people are rightly upset about the situation, but they’re led by the candidates to blame Barack Obama, yelling ‘kill him’ when Obama’s name is mentioned in association with former Weather Underground figure Bill Ayers, volunteering that Obama’s an Arab, that they fear for their lives if he’s elected president, and that the country is going ‘socialist.’

The McCain-Palin campaign and its right-wing supporters on talk radio and Fox News are trying to widen the fault lines in American on the basis of race, sex, religion and culture. If we allow ourselves to become divided along these lines in the middle of a depression, we won’t stand a chance to get the things we need. We already see the outlines of fascist ideology, where people blame immigrants or Black people or Arabs or feminists or trade unions or socialists because their future has suddenly become so uncertain. A disaster, economic or any other kind, can be endured only if we stand together and defend each other. We saw examples, both good and bad, in post-Katrina New Orleans.

Cynthia McKinney (Green Party) and Ralph Nader are each on the ballot for president in Florida, and, as expected, have much better platforms than the Democrats. McKinney, in particular, is an appealing choice–as a Georgia Congresswoman she bravely stood against the war and the Bush Administration’s attacks on human rights and civil liberties. However, she is polling at less than 2%. Florida is likely to be very close in this election. We live in a big state with a lot of electoral votes at stake. Floridians should think strategically when we vote. If the election is close enough to steal, the Republicans will steal it. Let’s not give them that chance. Their tactics are clear from recent years: In areas they control, they throw away votes, challenge Black and Democratic voters, engage in voting machine chicanery, and use intimidation and lies. So the election may turn out to be closer than we expect, which is another reason not to sit this one out.

But this election, even if there is an unprecedented Democratic sweep, is not going to be the answer to the fundamental problems with the way our economic lives are arranged. After the election, the hard work begins.

NLRB Outlaws Itself

July 23, 2008

July 23–In a surprising new ruling issued Tuesday, the DC Circuit Court issued an injunction against the National Labor Relations Board for “continuing to exist.” The request for the injunction came from the Board itself, in a case called NLRB vs. NLRB. The Board found that it was in violation of sections 7 and 8 (a) of the National Labor Relations Act and asked the court to enjoin “all future activities.”

The new doctrine is based on the board’s claim that it is itself an unfair labor practice. “I can’t believe we didn’t notice this before” said Board member Robert J. Battista, “Clearly we’re an employer, and clearly we are restraining employees from forming unions, so it was kind of a no-brainer.”

Another board member explained: “We were obviously an obstacle to the free flow of commerce and in violation of the constitutional right of business to do whatever the hell it wants.” When asked where in the Constitution this right could be found, he explained, “I’ve been golfing with my broker this week so I’ve been too busy to check that out, but I’m sure it’s in there somewhere.”

Labor law professor Harris Freeman, reached at the University of Massachusetts, said the board’s ruling was not surprising, given recent decisions, which he called “imbecilic” and “lacking even the vaguest grounding in reality.” However, he wasn’t opposed to the move: “They were just making things worse, really, so good riddance,” he said.

Private health insurance companies—regulate them or eradicate them?

July 11, 2008

On June 19th, twenty of us from Gainesville, Florida traveled to Jacksonville to protest my health insurance company, Blue Cross Blue Shield. The effort was part of a nationwide protest of insurance companies, led by the coalition Healthcare NOW: Cigna in Philadelphia, Aetna in Hartford, Humana in Louisville, and many more. The biggest demonstration occurred in San Francisco, outside the meeting of “America’s Health Insurance Plans,” the insurance lobbying group dedicated to blocking health care reform. Malinda Markowitz, a leader in the National Nurses Organizing Committee, explained the protest: “These insurance companies… profit by denying care to our patients–not by providing it. The American people are ready for guaranteed healthcare, through great bills like Rep. John Conyers’ HR 676, and we will no longer let insurers and politicians block progress.”

In Jacksonville, passing drivers honked vigorously when they saw our signs, “Health Care YES, Insurance Companies NO” and “Honk if you’re mad at your insurance company.” We met lots of new friends, union members in Jacksonville who are supporting national health insurance. Bunny Baker, a Machinist, said that a Blue Cross representative called the union hall to say he understood why we might protest other insurance companies, but “We’re the good guys, we’re nonprofit.” She told him that Blue Cross was denying vital care to a friend of hers, making it hard to tell the difference. For my part, my Blue Cross premiums have gone up 57% in the last 3 years, so it’s clear that even a “nonprofit” health insurance company is incapable of providing coverage affordably. We need national health insurance!

So I was interested when on July 8th I received emails from four separate national groups promoting a new campaign for health care reform. One was titled “An historic day for health care,” and indeed it did seem to be. The new coalition is called “Health Care for America Now” (HCAN) and according to the New York Times it will spend $40 million on ads and organizing leading up to the election. Political Action wrote: “Today, for the first time ever, all the major grassroots groups in America that work on health care are coming together to take on the HMOs and private insurance companies.” The linked HCAN website declared “Which side are you on?”–“for a guarantee of quality affordable health care for all” or “for leaving us on our own to buy private health insurance.”

It sounded promising. We certainly need to ‘take on’ the insurance industry. Our private insurance system is the reason U.S. health care is the most expensive in the world, not to mention inaccessible and stingy. The most comprehensive bill in Congress, HR 676, authored by Rep. John Conyers (D-Michigan), would kick out the insurance company middlemen. It would redirect towards care the money currently wasted on insurance company profits and paperwork. It would follow the lead of countries around the world which provide healthcare as a right.

But it turns out that for HCAN “taking on” the insurance companies doesn’t mean taking them out of our health care. Indeed, under HCAN’s plan, we would still be buying private health insurance. A brief inspection of the Health Care for America Now website reveals just the kind of tiresome incrementalism that hobbles U.S. struggles for national health care.

In fact, the plan espoused by the HCAN coalition seems to be very close to what Barack Obama and Hillary Clinton advocated all through the primary–regulate private insurance companies more, provide a mind-boggling patchwork of income-based subsidies (creating another layer of paperwork, tests and qualifications), and provide a public insurance alternative as a last resort. Worse, it continues to waste the money that could cover everyone. “The HCAN proposal forgoes most of the $350 billion annually in administrative savings possible under single payer national health insurance,” writes David Himmelstein of Physicians for a National Health Program (PNHP)

“The private insurance industry, as it functions today, clearly must be replaced with a system that works” says Don McCann, Senior Health Policy Fellow with PNHP. “So what is the solution proposed by the HCAN coalition? Let’s replace the private insurance industry with… the private insurance industry.”

There were other warning signs. In a press conference launching HCAN, Arlene Holt Baker of the AFL-CIO stated, “If we fail to enact comprehensive reform in the next Congress, employment-based health benefits–the backbone of our health system–will disappear in short order.” Most trade unionists have figured out by now: Job-based health benefits are precisely the problem. They burn up our power at the bargaining table, undermine our ability to speak out at work, make strikes even more risky and miserable, and lock us into jobs long past the date we might have been able to retire. Furthermore, if we’re too sick to work, we’ll lose our insurance, at just the moment we need it the most. Feminists chime in that job and marriage-based insurance makes a woman unnecessarily dependent on her husband–and his employer–for her health care. This is especially true if she is working part-time or raising children full-time. With true national health insurance, your health care doesn’t depend on what job you have, whether you have a job, or your marital status. This should be the goal. Instead, this campaign seems to be rallying us to salvage the current rotten arrangement.

It’s worth asking how we got to the point where groups that want to continue our private insurance system describe themselves as “taking on” the health insurance industry and advocating “guaranteed” health care. The movement to get private insurance out of our health care system has gained momentum as insurance costs have risen. Michael Moore’s film SiCKO introduced a whole new audience to the reality of well-functioning national health care systems in other countries. Unions all over the country have been signing onto HR 676–called a “single-payer” bill because the government (the ‘single-payer’) pays all healthcare costs. HR 676 has been endorsed by 33 state AFL-CIOs and 397 union organizations in 48 states. The U.S. Conference of Mayors signed on June 23. The funding mechanism, similar to that of Medicare, turns out to cost nearly everyone much less than they’re paying now, but allows for full coverage for the whole U.S. population. Around 90 members of Congress are signed on. Meanwhile, insurance company rate hikes and denials hit more and more people.

As a result, ‘taking on’ insurance companies is suddenly popular. Groups like MoveOn, which a few years ago would only talk about extending coverage to children, have changed their tune. But they still don’t get it. It’s not about extending our expensive and unreliable private insurance system to 47 million uninsured, it’s about abolishing a system that requires you to have “insurance” to get care. Private insurance companies make money by avoiding sick people. If you want everyone to get the care they need, you don’t regulate such entities, you eradicate them.

Traditional Medicare did just that for a market that the insurance companies didn’t want anyway: people 65 and over. The problems with Medicare were introduced by private insurers and HMOs, which have tried to entice away more profitable subsets of the elderly (only to dump them when they get expensive). As a practical matter, the Medicare experience teaches us that coverage and costs only get worse when private insurers are involved. HR 676 would essentially extend traditional Medicare to everyone, starting at age zero–and entirely eliminate the role of private insurance companies.

Contrast that to HCAN, which would leave insurance companies in place. “We need coverage that meets our families’ health care needs and is affordable, based on a sliding scale” their website states. “We need government to be an advocate for us and set and enforce the rules so insurance companies put our health care before their profits.” But a sliding scale means we have to prove our income–usually every year. And insurance companies are simply machines for making profit. Faced with new regulations, they just break the law until such time as they get caught, or can rewrite the law.

No wonder most people prefer Michael Moore’s admirably brief health care proposal: “1. Every resident of the United States must have free, universal health care for life. 2. All health insurance companies must be abolished. 3. Pharmaceutical companies must be strictly regulated like a public utility.”

Perhaps, you might say, well, it takes all kinds: There will always be the radical groups and then the more liberal groups. At least they’re doing something. What’s the objection?

My first objection is that the liberal groups in this case are cloaking themselves in radical language (‘taking on the insurance companies,’ ‘guaranteed affordable quality healthcare for all’) concealing their goals and suggesting they have more fight in them than they really do. They’re even using a confusingly similar name. The main coalition that’s been fighting for HR 676 is called “Healthcare NOW.” The new coalition is called “Health Care for America Now.” This trickery cuts off people who want fundamental change from those who are organizing for it, and diverts donations to what PNHP’s David Himmelstein calls “a placebo.”

My second objection is that HCAN is compromising away what people in the U.S. truly want, instead of joining the already existing fight to get it. For example, in a 2003 ABC News/Washington Post poll, 62 percent said they’d prefer a plan “in which everyone is covered under a program, like Medicare, that’s run by the government and funded by taxpayers.” Those who compromise the public’s interests always sell their watered-down programs by saying the public finds them more palatable. In reality, these compromises are more palatable to the nonprofit foundation complex many of these organizations represent. The majority in the U.S. want the insurance companies out–anything less is less than inspiring, and will lose support rather than gaining it.

My third objection is that their approach won’t work, even to get the measly reforms they seek. To win any kind of progress, there needs to be some threat. The gathering of organizations under the HCAN banner serves to reassure the insurance industry, not threaten it. And so reassured, the industry will continue to purchase politicians and conduct its murderous business as usual. It certainly won’t be put on the defensive.

The HCAN approach toys with, but then discards, the best leverage we have in the health care fight: The popular demand that insurance companies be kicked out of our health care system entirely. Eventually they will be, but it will be despite, not because of, the anemic plans of “Health Care for America Now.”

Go to for the real deal. Go to Physicians for a National Health Program for great explanations and analysis: Go to for the nurses’ take on the situation

Venezuela: “We never imagined we would see so many changes”

May 18, 2008

I first learned about the Bolivarian revolution in Venezuela when I saw a movie in 2003–“The Revolution Will Not Be Televised”–at a union function in New York City.

The movie was a mindblower. So many popularly elected socialist, progressive and populist governments have been overthrown in Latin America with CIA backing–notably in Chile (1973) and Guatemala (1954), but also Brazil, Argentina, Honduras, Panama, even tiny Grenada. In 2002 it looked like it was going to happen again in Venezuela. A business-class coup whisked away the elected president, Hugo Chávez, declared he had resigned, and occupied the Miraflores presidential palace, declaring themselves the new government.

The media was full of their plans and self-congratulations. Many longtime activists on the Venezuelan left made preparations to go underground. But then the pattern broke. The majority population, the poor and oppressed, marched on Miraflores and demanded their president back. Through their mobilized outrage, cooperation by loyal portions of the military and a great deal of luck, they won. The presidential pretender, Pedro Carmona, held power fewer than 3 days, during which he showed his ‘democratic’ intentions by dismissing the national legislature and Supreme Court. For his trouble he’s known as “Pedro the Brief.”

Jenny Brown

'When the media tell the truth, the walls will be quiet.' Photos: Jenny Brown

The more tidbits I learned, the more fascinated I became:

  • Venezuela’s 1999 Constitution has a provision that work at home (done mostly by women) has value and should be compensated in social security and in wages.
  • The gas company Citgo, a part of the Venezuelan national oil company PDVSA, started to provide low-cost heating oil to poor communities in the U.S. (The big for-profit oil companies claimed this was “unfair competition” and that Chávez was buying the loyalty of U.S. congresspeople.)
  • In 2004, after government meetings with School of Americas Watch’s Roy Bourgeois, Venezuela pulled its troops out of the infamous institution, dubbed the School of Assassins, in Columbus, Georgia. Venezuela’s lead was followed by Argentina and Uruguay in 2006, Costa Rica in 2007 (Costa Rica has no military but had been sending police), and now Bolivia in 2008.
  • When Chávez addressed the U.N. assembly in 2006, he not only implied that Bush was the devil, he held up Noam Chomsky’s new book “Hegemony or Survival” which immediately shot up in sales to #1 on Amazon.

Obviously something extraordinary was going on in Venezuela. Fellow Iguana editor Joe Courter and I spent 10 days there in late March with a 15-person peace delegation, traveling and interviewing Venezuelans both formally and informally. We spent time in rural and urban areas, in Caracas, Barquisimeto, Sanare, Carora, Choroní, and the tiny fishing village of Chuao.

The new Constitution

When Hugo Chávez was sworn in after winning election in 1998 he pledged allegiance to “this dying constitution,” because the platform on which he was elected promised to start a national process to write a new constitution. This was a national project which involved thousands of meetings. Ordinary people sent in their ideas to a constituent assembly, drafts were circulated and debated, and then it was voted on in December of 1999–71% voted yes. For several years after it was passed, people carried around the new constitution and would read it, quote it, argue about it, analyze it. Now that’s less common, we were told, because people pretty much remember what it says.

Rafael Nieves, an official in Carora, told us, “The process started with Chávez’ call to refound the country with the constitutional process of 1999–to make a new society based on justice. We who have been excluded are now participating–traveling from a representative democracy to protagonistic and participatory democracy.”

The new constitution is one of the most progressive in the world. It includes rights that many of us in the U.S. have been seeking for uncounted years. For example, it includes the absolute right to establish and join a union (article 95). All public and private sector workers have the right to strike (article 97). When there are doubts concerning application or conflicts among rules “that most favorable to the worker shall be applied.”

They have a 44 hour week by law and forced overtime is illegal (Article 90), and the constitution projects that work time should be reduced in the future. The proposed constitutional reforms of December 2007 were to have reduced the workweek to 36 hours, but the reforms were narrowly defeated.

Articles 83-85 say health is a fundamental social right, and in order to guarantee a right to health, the state will finance a public health system “governed by the principles of gratuity, universality, completeness, fairness, social integration and solidarity.” Public health services and buildings can’t be privatized.

While we still struggle for the Equal Rights Amendment here, article 21 says: All persons are equal before the law, and, consequently “No discrimination based on race, sex, creed or social standing shall be permitted.” The 2007 reforms would have added sexual orientation and state of health to the non-discrimination categories.

The Venezuelan constitution is also gender-neutral throughout, which is very intentional in Spanish, “Presidente o Presidenta,” “trabajador o trabajadora.” No ‘all men are created equal’ there.

Just as important, the constitution creates “citizen power” as a force–so there are Legislative, Executive, Judicial, Citizen and Electoral branches–and declares support for collective forms of ownership. These include encouraging cooperatives, making water a public good, and putting the money raised from selling oil into building the country with “humans at the center of the economic and political process” as foreign ministry official Roberto Poveda put it to us.

So that’s the written expression, but what’s the expression in the country? First, there was an explosion of new laws leading from the constitution. Along with the constitution itself, available in several inexpensive pocket editions, you can buy copies of laws from street vendors in Caracas, for example the law of cooperatives or the law of workers rights.

Health care

In each hillside neighborhood there is a Barrio Adentro health clinic, which translates as “inside the neighborhood.” The doctor lives on the top floor and works on the bottom floor.

The care is free, as are medications. They told us they dispense lots of medicines from the clinic, including birth control pills, but if they don’t have it they send you to a pharmacy with your prescription. Special pharmacies set up by the government give you 80% off, which they call solidarity pricing.

We asked if they have shortages of anything, they said no.

The tiny health clinic we visited in Palo Verde had a surprising number of medical staff: Two doctors (one Venezuelan and one Cuban), a nurse, and nine medical students, who go to class each day and also work in the clinic.

We spoke to Dr. Edita Goyo. The Venezuelan doctor is one of the minority of Venezuelan doctors who want to work with the poorest 80%–many refuse, some have emigrated to the U.S. and other countries, in fact, rather than heal the sick in their own country.

Dr. Goyo was already a practicing physician when the mission was implemented, but she went through a 2-year program in ‘integral medicine’ to train her for work in a neighborhood clinic.

Students out of high school who want to become doctors enter 6 months pre-medical training, followed by 6 years in college, and 2 years in integral medicine, for 8 1/2 years total. While nearly all the medical students are Venezuelan, there are also students from other countries studying community medicine. At the clinic we visited, we met a young Brazilian man who was getting his medical degree there.

Women’s rights

In addition to equality between the sexes, the right to contraception and contraceptive information is also guaranteed in the constitution. Abortion continues to be illegal (as it is everywhere in Latin America except Mexico City, Cuba, Puerto Rico and Guyana.)

We asked Doctor Goyo whether the clinic received any opposition from the church or anywhere else about birth control and she said no. The doctor said, however, that birth control and information was a lot harder for women to come by before the clinics were set up, that it’s much different now, “a world of difference.”

Gaudy Garcia started a women’s center in Monte Carmelo and a cooperative that does canning and makes preserves. She said: “Women are not only here to produce children, but we have knowledge and wisdom. But Machismo is deep in our culture, I’m guessing not just in Venezuela.”

She said in Venezuela there’s been a decade of ‘liberation feminism.’ “We don’t want to compete with men, we want to be equal with joint work and complementarity. We have shown our capacity is as significant as that of men.”

She has traveled a lot to other countries with her co-workers to represent rural women’s organizing. She said that sometimes of the men in their families don’t want them going out of the country to Mexico, Spain, and other places. They have argued with the men “we have to go, as women we are active people in this society.”

The constitution says that women are entitled to a pension, even if they only worked in the home, because the work of housewives is recognized formally as productive work. The 2007 constitutional reforms would have enacted a stipend for all housewives and informal workers (not necessarily women), close to the minimum wage, but that failed along with the rest of the reform package. The government does, however, distribute a stipend starting with the poorest, women who don’t have paid employment or insecure paid employment–that program is called Mision Madres del Barrio (Mothers of the Neighborhood).


Venezuelans joke that every time you turn around there’s another mission. The programs were set up as a way to get the public money from oil revenues to the community level. Very little of it used to escape the national oil company and what did ended up frittered away in government bureaucracy and corruption.

They describe the use of oil money for community betterment as “Sowing the oil.” In Caracas we saw an art exhibit of various artists conceptions of what “Sowing the oil” means to Venezuelans, a future of peace, art, prosperity, music, education, health and community.

Jenny Brown

Artist's conception of 'sowing the oil' at exhibit in Caracas.

Community Power

The municipality of Carora is a pioneer in applying the principles of community power, control and accountability. They have 200-some community councils all over their district. We met with people representing an urban community council and a rural one.

Aileen Escobar told us “We are constantly bombarded by the media saying the people aren’t ready to handle their own funds.” But she pointed out that under the previous government, 10% would be skimmed off the top, “so a dollar goes farther in our hands.”

They explained: “Community councils do a diagnosis of what the needs are of the community–health, housing, recreation, communication, transport (like buses). Resources are processed through Community Banks.”

Members of one of the Communal Councis in Carora.

Members of one of the Communal Councis in Carora.

In neighborhoods in Carora, every Thursday there’s a ‘Citizen Assembly’ which is the highest authority in the community council. Anyone can go and suggestions are discussed and considered. An elected executive group carries out the decisions. There’s a comptroller who is “always demanding transparency” and to know how funds are used exactly. (In both the councils we met with, this role was fulfilled by a woman.)

We were told, “When the old guard oligarchs–the ones who used to run the city council–come asking for additional services they’re told to organize their community councils like everyone else.”

We asked about problems. “As in any process, there are ups and downs” Carora official Rafael Nieves told us. “All change produces reactions and contradictions. For example, when we first got started everyone talked at once. So we needed norms of debate, norms of living together (convivencia).” Now they’ve developed those and “it’s been a beautiful experience when the previously powerless are able to bring power to bear” on issues facing them.

Aileen Escobar added, “Before, power was in the hands of an elite group. Now we’ve got it, we’re not letting go.”

We also visited Tintoreo, a rural town of 49 families about 20 minutes from Carora. The main industries in this flat, desert-like region are brick and tile making. With government assistance, the hamlet has recently built 13 new homes and when we visited they were celebrating the completion of two new school buildings.

They told us, “We have lots of things: Brick-making ovens. We raise goats and make roof tiles. Also vineyards. Cattle, Carora cattle is a special breed. Short root vegetables grow well. Not many insects. But we never had a government that cared about our zone before.”


Adalberto Chirino explained how the community council system works in a rural area: “We have lots of little communities with the same problems–almost all have councils. We meet to talk about themes that affect all of us. The figure/concept of community councils was in the constitutional reform. It didn’t pass but we’re still using the concept.” He noted that the leaders “are selected by the community, not by a party.” He said that “even barefoot” he could have a say. “It’s not like before when the mayor decided where the money would go.”

A retired teacher told us, “We never imagined so many changes in Venezuela.” Echoing a famous quote from Bolívar, he noted that unity was the key. “If you come together you will overcome.”


Higher education has been free but inaccessible to any but the elite because public schools were so miserably bad. One of our guides, Charlie Hardy, told us in his barrio, before the revolution, the public school was simply closed for 2 years.

We spoke with rural and urban students. The urban students were in a poor neighborhood of Barquisimeto and are involved in the Centro Cultural San Juan where they are learning Afro-Venezuelan drumming, music and dance, and volunteering to help younger students with their homework. Many of them are on their way to college (through Mision Sucre) and I asked them if they were the first in their family to go to college (I was thinking of their parents generation). They said “yes, our older siblings are very smart but they didn’t have the opportunities we have.” That’s how fast the changes have taken place.

We also spoke to students in rural Monte Carmelo who are in Mision Ribas, which allows students to go back and complete high school. They all work, so their classes are held in the afternoon and evening. When asked what they want to do after then get their diplomas, many wanted to study medicine or engineering. One student, who looked to be in her 30s, told us she walks several hilly miles to Sanare to work as a street cleaner in the morning, and comes home to Monte Carmelo in the afternoon to study to get her high school degree. She’s also in the national reserves. She said she’s “Studying to be somebody, and to be a model to my children, as well.”

The teachers in Monte Carmelo said they are working for “School reform, aiming for more horizontal relationships between teachers and students.” Nancy Garcia, one of the teachers, said she is sometimes “More a compañera than a teacher–but we have to sometimes be hard on them too, to push them.”

At this point 1/4 of the population has studied in the education missions. The programs use videos and books from Cuba, including a world-renowned literacy teaching program. The U.N. recently designated Venezuela as illiteracy-free.


We spoke to leaders in an organic farm cooperative and a chocolate growing cooperative. Both co-ops were started before the current revolution, but with government encouragement the number of coops has risen in the last 10 years from 800 to 180,000. At least one of the hotels we stayed in was a co-op, Posada El Cerrito, a former Tourism Ministry hotel in Sanare. The workers do not own the hotel and therefore can’t sell it for personal gain, but they operate it and pay themselves out of the proceeds. They said that it was much better that way because before, a manager would be sent by the Ministry, and he would come up with some bright idea they knew wouldn’t work, but they had to do it anyway because he was the boss. Now, they told us, they are able to make decisions based on their long years of experience as hotel workers.

La Alianza, the organic farming cooperative, is an example to others wanting to start co-ops–they teach about cooperativism and get government funding to do workshops for others wishing to start a co-op.

We asked the co-op president, who is known by his nickname ‘Polillo,’ what had changed since the revolution. He said he could spend all day telling us. But he said that people’s attitudes are slower to change. “Now there’s a lot of promotion of cooperativism, but there’s still a mindset of capitalism. The spirit of cooperatives is that you need less money to live happily (vivir feliz).”

He said that part of what they teach there is “Cooperative spirit–honesty, sharing solidarity, not to live our lives just for money–though we realize we need money–not so much envy of one another. It’s like taking on a lifestyle.”

At another agricultural cooperative–in Chuao, which is reachable only by boat–the chocolate co-op leader was very practical–he had a one-word answer to what had changed with the new government: “credits.” They could finally get loans from a community bank to improve things there. Their cooperative of 127 people rotates all jobs without regard to the sex of the worker, he told us. Complicated decisions, like marketing and pricing, are decided by majority vote, simple decisions such as daily work planning are carried out by an executive council of 6 men and 5 women. They sell dried cocoa beans to an Italian chocolate company for around $10 a kilo.

‘This is unedited’

Several of the people we spoke with emphasized, “This is unedited, this is a rough draft. We are in the process of learning how to do this.” Roberto Poveda, of the foreign ministry, said that they were “inevitable mistakes” but the important thing was to learn from the process, that it is “a process with hope.” He noted that despite some boondoggles, Venezuela is the first country to achieve the UN’s antipoverty “Millennium goals,” although he noted that these goals are not very ambitious.

Luz Marina is a youth leader in Frente Francisco Miranda. This youth organization, among other groups, was responsible for a nationwide replacement of incandescent bulbs with energy-saving compact fluorescents. Every small village and poor urban neighborhood we visited had made the switch. They also deliver food to those without it and spread the word about how people can benefit from the missions.

Luz Marina said, “We are struggling for a just and socialist society, part of being a youth is to have that spirit of struggle. We are100% anti-imperialist and pro-socialist and ready to give our lives for this revolution.”

“We are daily attacked by the media that we’re indoctrinated in Cuba, which they claim gives us guns to massacre the bourgeoisie.”

“Although we learn a lot from Cuba, the way it’s come to be, our revolution, our historical moment is very different, we have a very different culture, so it’s impossible to be dogmatic. This is our revolution.”

Luz Marina added, “We’re worried the same thing will happen to us as is happening to Afghanistan or Iraq.” Given the history of the U.S.’s moves to destabilize the Venezuelan government, this was not an unreasonable concern.

Shortly before we left for Venezuela, Colombia, which shares a long border with Venezuela, bombed inside Ecuador, destroying a rebel camp and killing the chief peace negotiator for the FARC–Colombian guerillas who are engaged in a 50-year long civil war in Colombia. The attack killed many while they slept, including several Mexican students who were there to interview FARC members.

Ecuador and Venezuela came down hard on the action, demanding that Colombia respect their borders. Tensions escalated but then suddenly subsided when the Latin American leaders met, including Colombian president Alvaro Uribe, and agreed to de-escalate. Observers of the meeting said Hugo Chávez led the effort for the accord. There is reason to believe the U.S.’s business as usual may no longer be working so well–creating a space for peace and hope in the hemisphere.

Venezuela—introductory resources

May 17, 2008

Here’s a starter kit of sites, books, and films those interested in the Venezuelan people’s struggle for participatory and ‘protagonistic’ democracy.

“Yes, it is important to end poverty, to end misery, but the most important thing is to offer power to the poor so that they can fight for themselves.”-Hugo Chávez, December 2004.

News and analysis from a variety of authors, includes the new Constitution in translation as well as a summary of the 2007 reforms.
US political economist Steven Brouwer’s notes from Venezuela-focusing on cooperatives and grassroots struggles.
“Chavez Code” author Eva Golinger’s website on U.S. efforts to undermine the government of Venezuela.
“Cowboy in Caracas” author Charlie Hardy’s reflections from Venezuela.


Understanding the Venezuelan Revolution: Hugo Chávez talks to Marta Harnecker. (2005) Book-length interview in which Harnecker asks many tough questions.

Charles Hardy, Cowboy in Caracas: A North American’s Memoir of Venezuela’s Democratic Revolution. (2007) Good quick introduction from a former barrio priest, in Venezuela for decades (originally from Wyoming.)

Richard Gott, Hugo Chavez and the Bolivarian Revolution. (2005) Progressive British journalist who’s been covering Latin America since the 1960’s.

Eva Golinger, The Chavez Code: Cracking U.S. Intervention in Venezuela. (2005) Golinger is a hero in Venezuela for obtaining documents proving U.S. efforts to destabilize Venezuela’s government.

Documentary films:

“The Revolution will not be Televised” Irish film-makers cover the quickly-reversed 2002 coup against Chavez from the inside.

“Venezuela Bolivariana” fast-paced history, overview, and talks with grassroots people. In Spanish, with subtitles. Can be viewed on the web at:

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