Healthcare: USA vs. Western Developed Nations

Some facts I’ve learned from my experiences as a neurosurgeon.

Before Obamacare

American healthcare is an enormous medical industrial business complex. It’s current annual cost is around 3.5 trillion dollars and is 17% of GDP, soon to grow higher. There is a lot more to the complicated healthcare business than meets the eye, involving many different players including doctors, patients, insurance companies, hospital administrators, pharmaceuticals, medical device manufacturers, diagnostics, nursing, home health services and of course the middlemen medical supply companies. While many of these players are conscientiously concerned about healing the sick, there are some in the industry who are trying to make a quick buck, if not incredible fortunes. Consequently, America spends the highest amount of money per capita (over $10,000) for healthcare. In spite of such high expenditures, America’s healthcare not only has less than adequate outcomes, but also leaves millions of it’s citizens uninsured and many more underinsured. On the other hand, many OECD (The Organization for Economic Co-operation and Development) countries provide universal healthcare spending an average of around $5000 per capita. They seem to get a better for their buck!

I believe one’s impression of American healthcare depends on how wealthy one is, whether one has employer provided insurance, how good that insurance is and if one had an experience of serious personal medical illness or that of a family member or not.

Even though many American citizens swear their American healthcare is the best in the world, many others are confused and scratching their heads wondering why the system is as bad as it is. I believe one’s impression of American healthcare depends on how wealthy one is, whether one has employer provided insurance, how good that insurance is and if one had an experience of serious personal medical illness or that of a family member or not. Also, if one uses the yardstick of measuring the health of a nation as a whole, including those that are poor or unemployed or chronically sick, one’s opinion will be less than stellar. Unfortunately, the nation does not seem to be keeping its promise promulgated in the Declaration of Independence on protecting the fundamental rights of Life, Liberty and the Pursuit of Happiness to all the citizens even though it affirms that, “… all men (and women) are created equal.” Without such affirmation, the Western developed societies seem to be more equal than the USA when it comes to providing healthcare. Comparing and contrasting the American medical industrial business complex with that of Western developed nations and expressing it in brief opinion statements will not do justice to the complexity of healthcare delivery. As a neurosurgeon, practicing for 24 years in Flint, MI, I am quite aware of that complexity through my personal experience.

Like any general neurosurgeon in a community practice, I took care of patients with all kinds of health insurance plans including many uninsured patients. Patients who were insured had varying benefits depending upon how good their insurance was. Senior citizens had Medicare which was reasonably good. The poor were covered by Medicaid and other equivalent insurance companies. Unfortunately, reimbursements by these companies for physician and diagnostic services were so bad many doctors wouldn’t accept their enrollees. The patients that had comparatively better benefits were the ones that had plans provided by commercial private insurance companies like United Healthcare, Aetna, Cigna and Humana and the so called non-profit Blue Cross Blue Shield. Premiums for such coverage were not only expensive, but also kept rising in cost every year. These plans gave a false sense of good coverage as long as the employees didn’t get sick or lost their jobs.  

The number one reason for personal bankruptcies in America is medical illness.

Some that were unemployed or had to buy individual insurance and not able to get group rates, found the costs prohibitive and opted to forego any insurance at all. Many who had private health insurance, mostly paid by their employers, felt their insurance was affordable, wonderful and they were happy with it. However, there were some unappreciated facts about private health insurance. One of the reasons the illusion that premiums for private health insurance were affordable was because companies would choose healthy members and deny insurance to the unhealthy with the excuse of pre-existing conditions. Also, the moment one developed any illness, like pre-diabetes for example, insurance companies denied benefits or simply terminated one’s coverage. I came across many self employed patients who lost coverage because of new treatable medical problems. Many thought they had good coverage with generous benefits only to find out that their coverage was meager, leaving them with thousands of dollars of medical expenses when a loved one in the family got sick. No wonder many went bankrupt!

The number one reason for personal bankruptcies in America is medical illness. Shockingly almost 70% of those that went bankrupt had private insurance.  Additionally, these insurance companies used preexisting conditions as an excuse to terminate coverage if the patient was deemed to be costing them significant medical expenses. If you lost your job, good luck with getting any kind of insurance. You may end up in ER, even for simple medical problems, increasing healthcare costs and thus becoming a burden on society. Doctors are mandated to take care of you in the ER but citizens are not mandated to get health insurance. Since the insurance companies were picking and choosing healthy enrollees and shedding those who were sick, the healthy enjoyed relatively low premiums at the expense of the sick. All that changed when Obamacare became the law of the land.

The Sick American Healthcare System & The Birth of Obamacare

Throughout my years of practice, one perplexing question has bothered me time and again; how can there be millions of citizens uninsured and many more underinsured in the USA, the most powerful country in the world with the largest economy? This question has sparked my interest to dissect and analyze the healthcare system in our country. I wanted to see if I could diagnose the root cause responsible for the ills of American healthcare. Having dealt with private insurance companies, pharmaceutical companies, device manufacturers, hospital CEOs and players in every facet of the American healthcare delivery for many years, it is not hard to diagnose the cancer that is destroying the system, if we can call it a system in the first place. That cancer is this: the fundamental principle that healthcare in America, instead of being considered a human right, is a profit oriented business driven by greed and perpetuated by a corrupt political system beholden to special interest lobbyists. It is the principal reason that underlies the uncontrollable, skyrocketing and unaffordable healthcare costs in America. 

The for-profit unnecessary middlemen private insurance companies, the greedy pharmaceutical and medical device manufacturers and the so-called not-for-profit hospitals that are, in reality, for-profit are the main culprits. Some doctors and many enterprises providing diagnostics, nursing and home health services are fraudulent and add to the escalating healthcare expenditures. Since greed and profit are significant components to the American healthcare delivery business, as long as government does not regulate it, and citizens continue to pay – it is inevitable for the costs to become unaffordable. As soon as he became president, Obama made healthcare reform the first major legislation of his presidency. His intention was good in that he wanted every American to have affordable and decent healthcare. He asked The American Medical Association for help because he knew the nation was not going to accept a Scandinavian style Single Payer System and wanted at least a public option. But Senator Max Baucus, who was the chairman of Senate Finance Committee, told President Obama if he wants any healthcare legislation to be passed with filibuster proof 60 votes in the senate, he had to forget the public option. The only reason that public option did not realize, was because insurance companies realized that such an option would be a formidable competitor which could kill their companies. They made sure politicians didn’t vote and providing solid proof of the influence and grip of private insurance companies over US Congressmen and women. Obamacare was born without any public option and became the law of the land.

The Death of Obamacare

When Obamacare became the law of the land, I predicted then, that noble it might be in its intention, the Affordable Care Act (ACA) was going to fail to provide universal, decent affordable healthcare because it did not harness the root causes of greed and profit. As a consequence, many citizens experienced increased premiums, became very angry with Obamacare and the conservative Tea Party was born. This Tea Party demanded the repeal of Obamacare. During the following midterm elections President Obama lost the Democratic majority in the US House of Representatives. The now majority Republican House of Congress attempted many times to repeal and replace Obamacare without actually providing a replacement plan even though Obamacare did have many good aspects to it.

There were 45 million uninsured and many more underinsured Americans resulting in 45,000 people dying annually before Obamacare. With the ACA and Medicaid expansion, 11 million uninsured were able to get some kind of insurance and their health got better compared to when they had no insurance. Health insurance exchanges allowed many to join the individual market and get plans which suited their economic condition. As a result, an additional 11 million citizens could become insured. There were other commendable aspects to the ACA.

Obamacare banned pre-existing condition denials, eliminated limits on coverage, expanded basic benefit packages, included preventive care, and allowed children to stay on their parents’ plans until 26 years of age. Also, insurance companies were restricted on claiming high administrative costs which included private jets, dining on gold rimmed plates, incredible salaries, stock options and bonuses for their CEOs. 

In order to maintain their profit margins, private insurance companies raised premiums, pushed medical expenses onto patients in the form of co-pays, high deductibles and co-insurances. President Obama trusted insurance companies to create healthcare exchanges which would provide affordable health plans to deliver as was promised. He also promised citizens could keep their private health insurance and their doctors if they were happy with them. Contrary to the promises made by President Obama, many could not keep their insurance or doctors. Little did the President know that the private insurance companies were not interested in providing quality affordable healthcare. Their mission was to make as much profit as possible for themselves and their stakeholders. Many charged higher premiums and eventually pulled out of the exchanges, all the while making incredible profits. No wonder there was a backlash against Obamacare. Unfortunately, President Obama received all the blame instead of the greedy useless middlemen-for-profit and so called non-profit insurance companies.

The Tea Party and many Republican politicians fanned the flames of hatred towards the fear of Obamacare becoming a government take over that would turn America into a socialist country. That didn’t happen, but still many have a deep visceral hatred towards Obamacare, aligning it with the likes of socialism and communism. 

It would be interesting to know, how many Americans have traveled to Scandinavian countries to see for themselves how their healthcare systems are run. I have personally come across many patients who’ve hated Obamacare, calling it socialized medicine, even though they were getting benefits by the ACA. I am surprised at the extent of animosity towards the ACA, even though millions of citizens have gained access to some healthcare as opposed to none before Obamacare. This has inspired me to pick up my camera and to go around the world to shine the light of the truth of healthcare in America and other comparable developed nations.

Healthcare in Western European Nations

As part of my journey to understand and compare the American healthcare system to that of the Western European nations, I’ve traveled to France, England, Germany, Sweden, Holland, Denmark and also the former communist countries; Czech Republic and Hungary. I’ve talked with doctors, as well as, ordinary citizens. I came to know many facts about their healthcare systems. Contrary to the USA, many of these developed nations consider healthcare a human right and not a profit-oriented business. There is no country among them with perfect healthcare systems, but they do provide better universal healthcare for much less than that of America. They do it by way of just and fair government oversight of all the players in healthcare delivery and by controlling prices. Consequently, there is a reining in of uncontrolled greed and profit. Whereas America allows greedy, profit-oriented enterprises to dictate the markets, expecting them to be fair. Unfortunately, this is unrealistic. One of our founding fathers realized this truth that government oversight is essential. Without such monitoring selfishness reigns unchecked. 

“If men were angels, there would be no need for government; but men aren’t angels.” – James Madison

The democratic socialist countries have grasped this truth and implemented checks and balances over greed and profit through systems that suit their countries. We don’t have to reinvent the wheel. We can pick and chose the ones that suit our country. Here are some of facts I’ve learned through my global journey documenting healthcare systems:

  • First of all, there is no free healthcare in any of these countries, including the democratic socialist Scandinavian ones. Healthcare is paid for by taxes from citizens which are progressive depending on one’s income. By the way, in Denmark and Sweden those taxes provide not only decent healthcare but also cover other costs for children up to and including university education. For that reason, they do not complain much about paying taxes (see video: As an American citizen, I pay a lot of taxes but get zero healthcare or education relief for my family and myself. Instead, I see a lot of those taxes going towards unnecessary wars and tax breaks for the wealthy.
  • In order to ensure healthy citizens enroll in health insurance to achieve lowered premiums for everybody, the government must mandate buying health insurance. I remember talking to a girl in Amsterdam, Netherlands the day before her 18th birthday. She said on her 18th birthday she has to get her own health insurance and would no longer be on her parents’ plan. With individual mandate repealed in the USA, the premiums will continue to skyrocket.
  • There is an impression that some people in socialist countries are lazy, non-working moochers who still get to reap all the benefits. Sweden makes sure their government looks for jobs for the unemployed who are receiving unemployment benefits. If they refuse to take that job their benefits will be cut off. In America I see so many patients applying for disability and getting it without any significant physical or mental handicaps. The lawyers that are part of this disability benefits industry are making it worse, because they benefit financially from securing such benefits for their clients.
  • Regarding insurance company profits, Western governments make sure there is a decent benefit package and ensure a limit on CEO profits and salaries. In spite of it, the more the insurance companies are involved in healthcare delivery the more expensive the system becomes. That’s why Switzerland, which has significant participation by these companies, costs close to what America costs per capita.
  • As far as pharmaceuticals, in France patients don’t pay much for drugs. The country does not allow price gauging. Also PhARMA dictates the prices. The PhARMA lobbyists influenced politicians to forbid Medicare, the largest health insurance entity in the world, to bargain for discount prices through its economy of scale. How is this fair market economy as they claim America is?
  • Device manufacturers in Germany sell directly to hospitals with one of their employees as a liaison to make sure there is smooth supply of devices and the medical personnel are properly trained. They are also available to troubleshoot. In America, there are layers upon layers of distributors. A national distributor that contracts with a regional distributor who in turn contracts with state distributors. The state distributor then contracts with sales people for different locations in the state. No wonder a spinal pedicle screw in America costs 50 to 100 times that of the actual manufactured cost and is many times higher than in other countries.
    By the way, the health insurance companies, which are unnecessary middlemen to begin with, also have middlemen; middlemen for middlemen! They are called insurance agents or brokers who are actually recruiting enrollees by promising comprehensive benefit packages but delivering skimpy benefits and denying claims for medical costs. They add unnecessary administrative and profit costs which then explains unaffordable premiums. While patients are going into debt or bankruptcies, brokers and CEOs of the insurance companies they are channeling the enrollees to live lavishly and fly around in private jets.
  • Doctors get paid more in the USA upfront but pay for health and education and other ancillary services like nursery care later. One of the orthopedic surgeons I talked with in Paris, told me that in France taxes are taken out upfront for education, healthcare and other services so the doctors’ take home pay is less but evens out.
  • Hospitals are paid like global budgets and non-profit hospitals are generally managed as such, not as for-profit as done in America. By the way, the CEOs of these non-profit hospitals in America make millions without ever putting a single dollar of their own money as an investment. They play with hospital money. In England the hospital administrators get salaries, not huge bonuses.
  • Even the ex-communist countries like the Czech Republic and Hungary, abandoned the communist political system but kept state run universal healthcare system.
  • Every citizen in Canada, our neighbor to the North, gets a Medicare card which covers their essential healthcare needs from birth till death. The emergent care is taken care of appropriately. Of course, many Americans ask the question, why do Canadians wait longer, than in America for non-emergent healthcare interventions? That is the wrong question to ask. As Americans, we should instead be asking a different question; how can we allow 30,000 citizens to die annually due to lack of healthcare in the most powerful country on earth? Everybody knows, it is always better late than never.

Obamacare is not perfect, but Trumpcare will be worse. President Trump said, during his presidential campaign in 2016, that he was going to provide the best healthcare for cheaper prices and it was going to be “easy.” The moment he became president, he said nobody knew healthcare was so complicated. He may be the only one that thinks healthcare is easy. As long as President Trump surrounds himself with cabinet members who are ex-lobbyists, like Alex Azar who was a PhRMA lobbyist, pharmaceutical costs will remain uncontrolled. Trump’s idea that private insurance companies can be trusted to bring premiums down is pure wishful thinking. Additionally, his plan to privatize Medicare and Medicaid will only make healthcare unfortunately more unaffordable.

Unless government oversight either eliminates or significantly reins in the greed and profit in the medical industrial business complex the ills of American healthcare will not be cured. It is time to create a society that is  true to the fundamental American principle of guaranteeing Life , Liberty and the Pursuit of Happiness to all citizens.


American Healthcare: A Sad and Nightmarish Experience

A couple of days ago my healthcare documentary, “SCREWED by the Greedy Business of Healthcare in America,” had a screening at Wealthy Theatre in Grand Rapids, MI. Before the screening, a lady from the area was introduced who shared a moving personal story regarding her nightmarish experience with American healthcare. 

The ordeal started when she underwent treatment for cancer. Unfortunately, she developed heart failure from chemotherapy induced cardiomyopathy. She could not continue to work, and the treatments exhausted her savings. She was still suffering from heart failure. She qualified for Medicaid, but all of her treatments weren’t covered. The doctors gave a grim prognosis unless she had a heart transplant. They told her it would be difficult and almost impossible for her to receive, or to even get on the list for, a transplant.  She was informed her situation was hopeless, but she refused to give up. She fought to be placed on the transplant list. In October of last year, she was sent a letter from the heart transplant board at the local hospital stating she was not qualified for placement on the transplant list because she does not have enough prescription drug coverage.  In November, she received another letter informing her that, unless she has $10,000 funds available for prescription drugs, she would still be not eligible to be on the list. Fortunately, she was able to raise that money through crowd funding. She is currently waiting for a call telling her the right heart is available for transplant. 

Sadly, in America her story is not unique. In fact, such nightmares are more than common.  Thousands, if not millions, of citizens go bankrupt from a medical illness suffered by themselves or their family members, which is the number one reason for personal bankruptcy in this country. A million Americans will go bankrupt this year from medical related costs. Ironically, 70% of those will have private health insurance but will not be protected. It is a shame that millions of citizens, in the most powerful and one of the richest countries in the world with the largest economy, have to crowd fund or go bankrupt for healthcare. It is even of a worse shame that 30,000 of the 30 million uninsured Americans die every year due to lack of timely healthcare. 

The experiment of unnecessary middle man private health insurance companies in America that charge unaffordable premiums, deductibles and co-pays has failed to provide affordable, quality healthcare to all its citizens. Not to the CEOs of those companies, though. They have succeeded in amassing millions, at the expense of financial hardship of the enrollees of their companies. It is time for America not to be the only industrialized nation that does not guarantee quality affordable healthcare as a human right and to join all the others that provide such universal healthcare. 

There are a few options, single payer or otherwise, to achieve universal healthcare but Medicare for All is the simplest and the best of them all. It is a publicly funded but privately delivered option that offers more choice of doctors, hospitals and comprehensive benefits that are affordable too.

Medicare for All is even likely to reduce healthcare costs for all Americans in future.

Related Links:

Bernie Sanders and Alexandria Ocasio-Cortez’s Democratic Socialism vs. Trump’s Crony Capitalism!

Believe it or not, I sat through President Trump’s entire 2019 State of the Union address! Nothing unexpected from his reading of the speech off the teleprompter, but one part of the speech caught my attention. He proclaimed, “Tonight we renew our resolve that America will never be a socialist country.” I wonder if he truly understands the word socialism, especially democratic socialism. I doubt it. 

Trump is not a man of philosophical or ideological convictions. He’s not the kind of guy who seeks knowledge or is interested in reading or understanding anything other than business deals that personally benefit him; whether legal or illegal, ethical or unethical, proper or shady. I do believe, though, that he has personal and political reasons to bash socialism. After all he has benefited enormously from the crony capitalism pervasive in the American economic and political system since he was very young. But first I need to explain what crony capitalism and democratic socialism mean, in case you are wondering.

Tastes Like Crony CapitalismCrony capitalism is a term describing an economy in which success in business depends on close relationships between business people and government officials. It may be exhibited by favoritism in the distribution of legal permits, government grants, special tax breaks, or other forms of state interventionism.”

On the other hand, “social democracy, now often referred to as democratic socialism, in which extensive state regulation, with limited state ownership, has been employed by democratically elected governments (as in Sweden and Denmark) in the belief that it produces a fair distribution of income without impairing economic growth.”

The key difference between the two socioeconomic and political philosophies involves the robust state regulation and oversight in social democracy and lack there of in crony capitalism. Notice that Socialism is a system wherein political representatives are “democratically elected” to ensure “fair distribution of income” to citizens.  Such systems require extensive state regulation but “limited state ownership.” Whereas favorable state interventionism beneficial to businesses, achieved through close relationships with corrupt politicians euphemistically called “lobbying” in America, permits and is essential for crony capitalism to flourish. It is not hard to see why Trump is a beneficiary and hence a strong proponent of crony capitalism and is profoundly averse to democratic socialism. He simply hates government oversight.

Many who knew Trump well claim that he showed affection for crooked business practices before he became a president and has been a poster boy for crony capitalism after occupying the White House. Apparently, according to Trump, he borrowed a mere one million dollars from his father to start his real estate business but the truth may be that the loan was more than just a million. An extensive report in The New York Times, however, concludes that he inherited over $400 million from his father’s real estate fortune by engaging in “suspect tax schemes”. Then there were the suspect businesses of Trump University and Trump Foundation, which had to be folded recently due to possible illegal practices. 

The billion dollar question though is:  did Trump and his children (as well as his son-in-law) engage in illegal or unethical (or both kinds) of business practices to build their real estate empires? Can that be the reason why he bucked tradition and didn’t reveal his taxes before the presidential election, and continues to fight to keep them from becoming public? The more serious issue is whether money was laundered into his businesses from shady foreign sources. Many are wondering if that could be the reason why he has been inexplicably very friendly with Putin, Russian oligarchs and the Saudi royal family well before – and during – his presidency.  Various committees in the Democratic Party-controlled House of Representatives are launching hearings to determine the underlying reasons for Trump’s cozy relationships with these undemocratic foreign nations.

Trump has been a shameless champion of not only crony capitalism but also nepotism. He gave enormous powers to his daughter Ivanka Trump and Jared Kushner, his son-in-law, in spite of Jared not getting FBI security clearance. Ivanka wields enormous influence on him and rubs shoulders with leaders of many nations even though she has no political experience whatsoever. I am not sure what their qualifications for such position and power are. Nepotism appears to be the one obvious explanations I can think of.  At the same time, both his daughter and son-in-law may share the same questionable business values and practices as Trump, and may value the necessity of keeping any shady deals in the dark.  

Ethical and moral business practices, being a responsible citizen, paying due taxes and contributing to the society from which he benefits are not values Trump bothers about. He bragged that he contributed to the politicians from both parties who write the laws – laws which may be immoral or unethical, but are legal and beneficial for businessmen like himself.  This is a characteristic of crony capitalism that allowed him to personally amass considerable fortune. And it helps explain why he appears to be committed to amplifying and perpetuating crony capitalism while demonizing democratic socialism. The unfortunate fact is, he has the power and the bully pulpit to do both in his role as the president of USA.

Trump campaigned and won the presidency promising that he was going to drain the swamp in Washington, DC. He also said he would promote legislation that would benefit the middle class.  In reality, he has come far from fulfilling either campaign promise. In fact he and his cabinet could never identify with the lives of middle class Americans and are possibly the “swampiest” ever in American history. He chose billionaires as his cabinet members: Treasury Secretary Steven Mnuchin, Education Secretary Betsy Devos and Commerce Secretary Wilbur Ross, all of whom may also have benefited from crony capitalism. When Dr. Tom Price, his Health and Human Services Secretary had to be fired for ethical reasons, Trump hired ex-pharmaceutical industry lobbyist Alex Azar to replace Dr. Price. Mr. Azar, by the way, earned millions lobbying for greedy PHARMA.  No wonder Trump and other Republican politicians rammed new tax legislation through Congress that gives billions worth of tax breaks for real estate moguls like himself and to corporations.  These tax breaks to the wealthy and to corporations have had the consequence of increasing the national debt by around 1.8 trillion dollars.  Meanwhile, this tax legislation package gives mere crumbs to the hard working middle class.  This is a classic case of crony capitalism, and it is anathema in democratic socialism. 

There are many political reasons for Trump to start negative and false propaganda against socialism, and try to shift the national conversation to condemn democratic socialism.  Trump’s presidency and his leadership are becoming unpopular. Coupled with the popularity of Bernie Sanders (a Democratic Socialist) and the recent shellacking of Republican House Representatives by young, energetic (many female if I might add), progressive democrats like Alexandria Ocasio-Cortez may be perceived by Trump as a warning of potential danger. Trump may also be thinking about the possibility that these new legislators could move  the national political discourse towards what is considered by many from the right as support for democratic socialism. His businesses and personal finances as well as foreign policies toward Russia, Turkey and Saudi Arabia are coming under increasing and intensified scrutiny by the new Democratic-chaired committees in the House of Representatives. His bid for reelection could be in peril. It is understandable why, during the recent State of the Union address, he launched a preemptive strike against what he believes are the winds of socialism blowing in America. Watch out for this to be his incessant theme for the upcoming reelection campaign.

During the 2016 campaign, Trump was very effective in whipping up hatred and fear about Mexican rapists, MS13, and other violent, illegal immigrants from Central America. Was there a dose of white nationalism also? You decide for yourself! The 2020 presidential campaign strategy is more likely going to involve fear mongering about America becoming a socialist country. He is ignoring the fact that we already institute a few highly popular social programs:  Social Security and Medicare, for example. I have a feeling that he wants to make socialists and democratic socialism the dirtiest words in America during the next campaign. I won’t be surprised if Trump took aim soon at the rising popularity of Alexandria Ocasio-Cortez (AOC), a representative with progressive ideology who is not ashamed to be labelled a Democratic Socialist. The statement that America will never be a socialist country may be a subtle dog whistle to die hard Trump supporters! He may also be thinking it can be a winning campaign slogan. Trump really knows the pulse of a significant population of Republicans, who he is counting on to reelect him in 2020. When it comes to touching a sensitive nerve and eliciting an emotional, deep visceral hateful reaction among his followers, Trump is a genius!

Many of Trump’s loyalists, right wing talking heads and other conservative pundits on FOX News are quick to jump the gun and they have already started the propaganda to label the progressive, democratic, and  socially beneficial safety net policies, “Socialist”! Many go even further and equate democratic socialism to communism. I can guarantee they don’t know the fundamental difference between the two political philosophies. It is not hard to find out. All they have to do is just “google it.”  In case they don’t want to, let me help.

In “communism there is societal and communal ownership and governance of the means of production, (no private ownership) and the eventual establishment of a classless society.” (Merriam-Webster Dictionary)

Unlike democratic socialism, communism does not allow individual ownership, which is a surefire killer of many citizens’ interest for innovation or hard work in the long run. 

That’s precisely what happened in Russia and China when those countries tried communist political philosophy. There was initial empowerment in both countries immediately after their respective revolutions, but communism failed in the long run because Karl Marx’s communist doctrine underestimated the power of the self-interest of people, and their desire for ownership and accumulation of personal wealth. On the other hand capitalism generally succeeds because it allows for self interest and rewards hard work. Hence, we see the recent transition of both those countries to market economies, but parts of the communist political structure and methods of governance still persist.

While communism is on one end of the socioeconomic spectrum, greedy capitalism is on the other end  – with an enormous gap in between. Unregulated capitalism becomes a social problem when it becomes predominantly profit oriented, at any cost or means, resulting in worsening inequality and poverty, as is currently happening in America. The inequality is not as profound in Scandinavian countries which respect and follow the principles of democratic socialism. Scandinavians still follow reasonable capitalism that rewards hard work and private ownership but governments there monitor and regulate any unfair or unethical means of accumulation of wealth. Hence the gap between the haves and have nots is not nearly as wide in those countries as it is in America. Additionally the citizens of these countries are consistently the highest among all the nations of the world in reporting happy lives. Trump and his posse never mention that fact but are quick to point to what’s happening in Venezuela, as he did in his State of the Union speech. They say that America will “become Venezuela” if socialist ideas and policies are allowed. 

Venezuela is not a true democratic socialist country. The primary source of revenue in Venezuela comes from the oil industry, which is owned by the state. Venezuela had problems due to volatile oil prices, mismanagement by the state, and resistance by the wealthy elite class against socialist government. The covert and overt American intervention in that country’s domestic affairs, probably due to oil interests, didn’t help the country any either. In fact it fueled the fire of unrest and turmoil, pushing millions into poverty and causing many to flee Venezuela. Relying on the military became essential for President Nicolas Maduro to survive, which unfortunately curtails freedom, making matters even worse. The situation in the democratic socialist countries is far from that of Venezuela; there is no comparison.

Trump also asserted during the State of the Union that, “America was founded on liberty and freedom, and not government coercion, domination and control. We are born free and we will stay free.” I think this statement is a dog whistle for his ardent supporters. The true democratic socialist countries do not curtail freedom. I have been to Denmark, Holland and Sweden. I have personally talked to people there. They have freedom, choices and also get a much better bang for their buck as far as their taxes are concerned. An average middle class citizen pays 30% taxes and gets quality healthcare and education up to and including university for their children. I pay more than that in federal taxes and get zero healthcare and education benefits for my family as an American citizen. It doesn’t matter whether you call it socialism or something else, why is that not a better system than greedy crony capitalism?!? The citizens of those countries also enjoy a robust social safety net if they get sick or become unemployed. While employed, they have lengthy paid time off for pregnancy and parenting as well as support for child care. They even have significantly more vacation time for rest and relaxation than American employees. Their productivity is not compromised and is comparable to that of America. Scandinavians are also conscious of and working to remediate the destruction being caused by climate change. Citizens of those nations believe in and embrace policies promoting renewable energies. To them protecting our blue planet, the only one that we know of that gives and sustains life, is more important than greed and amassing unimaginable personal wealth. In contrast, it appears that many American businesses prefer unregulated greed and profit that trumps (no pun intended) the concern for the well-being of Mother Earth. 

Self proclaimed Democratic Socialists like Alexandria Ocasio Cortez and Bernie Sanders take global warming seriously and want to do something about it. AOC’s Green New Deal is a start. Instead of acknowledging the climate crisis and working with them, Trump attacks those policies and doubles down on democratic socialism. I wish, while in Helsinki, instead of having a secret meeting with Putin, Trump had a chance to meet the citizens of Finland and get a sense of their lives and how they feel about their democratic socialism. He might have gotten enlightened –  but then I wouldn’t bet on it. This is Trump we are talking about. He could care less about rule of law, or democracy, or social equality. His goal is personal enrichment. He will shamelessly ignore or dismantle any societal oversight or laws that are in the way. He is undermining the justice and intelligence institutions considered to be the foundational pillars of American democracy. He may be really concerned about any incriminating truth that may come about in the Mueller investigation. The plethora of ongoing and potential future litigations as well as congressional committee investigations against him (and many of his business and campaign associates) must be causing him nightmares. This might also be behind the fear and loathing Trump exhibits toward government regulations, as evidenced by his unparalleled slashing of regulations that protect workers, ensure clean air and water and preserve the pristine forests and state parks – all in the name of economic prosperity. 

One of the founding fathers, John Adams, understood why we need state/government regulation. He said, “If men were angels there is no need for government.” He recognized the selfish nature of men, and how, if left to their own devices, societies will devolve into predatory jungle law. The consequence of lack of government, he predicted, will be selfishness of the rich and powerful triumphing over justice and fairness for the vulnerable and the helpless. Unfortunately we see that in the current state of affairs in America – where already inadequate government oversight is being systematically eroded further; thanks to Trump who doesn’t know when to say enough is enough! There is a reason why the founding fathers crafted a constitution that distributes power among co-equal branches of the Congress, the Supreme Court and the Presidency. 

They must have envisioned people like Trump who need to be kept in check through necessary, adequate, and effective governmental oversight. I hope the Supreme Court would judiciously limit Trump’s overreach. If not, nepotism and unregulated greedy crony capitalism will thrive and exacerbate social inequality. Unfortunately, with a bench that is made up of a conservative majority, I am not sure if that will happen. 

Do we have a better alternative?

Looks like there may be one, and that is:  electing to congress more senators like Bernie Sanders and house representatives like Alexandria Occasion Cortez to rein in Trump and his Republican accomplices who are taking the country down a dangerous path. The Republicans  beat their chests with patriotic fervor but are not doing much to protect the country from what almost amounts to cyber warfare attacking our democracy They talk about the rule of law but give a pass to Trump who breeches it. They say they are the guardians against presidential and government overreach, but have been derelict in their duty. Time and again they profess family values, but their allegiance to Trump undermines that. Most importantly, they say they are fiscally conservative, but irresponsible tax cuts and unnecessary wars are ballooning the national debt. I guess the Republicans are in reality sham patriots, with opportunistic morality, Frankenstein foreign policies and flexible family values. Their phony fiscal conservatism and predilection for crony capitalism will drive many more from the middle class into poverty in America. It is time for responsible citizens to get informed, take a serious, rational, and open minded look at alternative socio-economic philosophy.  There are alternatives to the current greedy crony capitalism in these United States of America.

It really doesn’t matter whether you call such a system democratic socialism or responsible capitalism. As long as it creates a society that allows all the citizenry – as a collective and as individuals – a good life, liberty, and the pursuit of happiness, it is the right system!

Kamala Harris vs. Billionaire Boys and The Unnecessary Middlemen Health Insurance Companies


At a recent CNN Town Hall meeting, Senator Kamala Harris was asked about how she would bring quality, affordable healthcare to all Americans.  She replied that Medicare for All (M4A) would be the solution to fix the sad state of American healthcare. She was also asked if that would mean that all the private insurance companies would be eliminated. She said there was no reason for the insurance companies to be the ones that authorize or reject a treatment or intervention that a qualified physician recommends to his or her patient.

As a neurosurgeon who has been in the medical field for 23 years (and deals with the frustrating authorization process imposed on doctors by the profit oriented and unnecessary middlemen known as health insurance companies on a daily basis), I am in 100% agreement with her answer.  Here is the reason:  Imagine your car gets sick and you take it to a mechanic. The mechanic diagnoses the problem and says it costs $100 to fix it. Meanwhile a middle man insurance company says, “Wait! Give me $125. I will pay the mechanic $100 and will keep the $25 as administrative costs.” You wouldn’t pay that extra $25 to that unnecessary middle man, would you? Why then, would you need the unnecessary middlemen health insurance companies? 

Mr. Howard Schultz, the billionaire CEO of Starbucks who is considering a bid as an independent for the presidency of the United States, said that elimination of the private health insurance companies would be “un-American.”  He also said, in a recent CNN interview with Poppy Harlow, that Medicare for All is “unaffordable.”  Another billionaire, Michael Bloomberg agreed about the cost for M4A.  Billionaires apparently think alike.  Even though Mr. Schultz has become a successful businessman selling coffee around the world and Bloomberg with his immense financial empire, I am not sure how much they understand the complex business of American healthcare delivery. 

Mr. Schultz said that he believes he understands healthcare very well, and that the issue is close to his heart. His claim for the knowledge he possesses about health care is based on his provision of comprehensive healthcare to his employees. I commend his compassion but that compassion is no match for the greed of pharmaceutical and health insurance companies, hospital administrations, and device manufacturer companies.  These special interests all lobby, control, and dictate the current healthcare policy in America. Mr. Schultz seems to believe that just because he provides healthcare benefits to his employees in his private business, he believes he has a better way to provide healthcare for all Americans than a national Medicare for All policy.  Apparently that “better way” would be to tell the CEOs of corporations and businesses in America to do what he did for Starbucks employees; be compassionate and provide healthcare benefits to the employees. He thinks they will follow his example. 

Good luck with that!

I am perplexed by Mr. Schultz’s belief that appealing to the corporations to be compassionate will solve the very serious problem Americans face with having our healthcare delivered through for-profit intermediaries. It is hard for me to believe that Mr. Schultz could be that naive. He must be aware that the shareholder economy in America doesn’t give a damn about compassion. The majority of corporations are all about the bottom line and making as much profit as possible for their shareholders. He thinks that, as an independently elected president, he would control the special interests in the healthcare industry. Looks like he has not been watching what’s going on with the presidency of President Trump.  Like Mr. Schultz, Mr. Trump is an independent billionaire, but one who has failed to accomplish any meaningful reform in the healthcare delivery that would provide quality, affordable healthcare to all Americans. 

In spite of being a businessman Mr. Schultz doesn’t seem to understand that the “business of America is business,” and that business is only concerned with creating profit for shareholders. The chance of the greedy millionaire and billionaire CEOs of pharmaceutical, private insurance, device manufacturer and hospital industries following Mr. Schultz’s example and foregoing their annual salaries, bonuses and stock options that are worth millions, if not billions, is almost zero.  

I am uncertain what imaginary utopian healthcare dream Mr. Schultz is dreaming of! He definitely needs to wake up and look around and see the healthcare policies perpetuated by the corrupt political system, beholden to the greedy and very powerful healthcare special interests.  

Universal Healthcare to ALL New Yorkers

New York’s mayor, Bill De Blasio, recently announced that New York is officially on its way to becoming the first city in America to ensure that all New Yorkers (including the undocumented) will have comprehensive and affordable healthcare. Given the Republicans’ effort to dismantle Obamacare, this would be an incredible accomplishment. With the Right’s mindset that government funded healthcare is “socialized medicine” alongside the powerful grip of corrupt politicians by the greedy pharmaceutical, hospital and insurance industries; Mayor De Blasio is a hero for taking matters into his own hands. If he can make this plan a reality, it would be considered a monumental achievement and the Mayor should be hailed as a pioneering politician that has initiated a seismic shift in the philosophical and political landscape of the American healthcare delivery.

After listening to his press conference in which he announced his plan, it looks like De Blasio has understood the key principles necessary to achieve universal healthcare to all New Yorkers. The first among those is the basic, fundamental philosophical principle that he reiterated time and again; that healthcare is not a privilege but a human right. I truly believe this is the most important ideal the nation, as a whole, has to accept in its collective consciousness if universal healthcare is to become a reality in America. The mayor has embraced that core belief wholeheartedly and guaranteed comprehensive healthcare to every New Yorker.

The second principle he spoke about is the need for access to preventive and primary care doctors. When thousands of uninsured and underinsured citizens are guaranteed healthcare and connected to primary care doctors, the burden of unaffordable premiums, deductibles and copays will be lifted off their minds. This would facilitate as well as help persuade individuals to seek preventive and early medical care.  The Mayor’s administration has partnered with NYC Health + Hospitals, to bring about lowered city medical expenditure. These significant savings are being used to provide quality health care to more and more uninsured and underinsured.  Because emphasis on preventive and primary care decreases healthcare expenditures, De Blasio has allocated an additional 100 million dollars in the city budget to provide guaranteed healthcare to 600,000 uninsured New Yorkers. He believes that money will be worth the bang for the buck.

The third important principle, which has already been put into place, is in New Yorkers having a public option, MetroPlus Health Plan. The objective of this health plan is comprehensive medical care for the sick New Yorkers irrespective of their ability to pay. There is no greed or motive for profit here. Hopefully, many citizens will realize that a not for profit public option is a better choice, as well as an alternative to the greedy for-profit health insurance companies. If many citizens enroll in a public option, there is a chance the greedy for-profit insurance companies can be reined in or put out of business. The recruiting efforts and activism of people involved in Get Covered NYC have already brought in many uninsured into the ACA Exchanges and have also given the choice to enroll into the public option of Metro Plus Health Plan.

Finally, the mayor recognizes that mental health is equally as important to that of physical health.  Thrive NYC is the coordinating mental health component of his healthcare plan being guaranteed to all New Yorkers.

Since the mayor has all the necessary pieces in place to achieve universal healthcare for all New Yorkers, I believe it will be accomplished! It is not a single payer plan but integration and coordination of all the existing healthcare delivery components under NYC Care with emphasis on continued improvement of the healthcare delivery. The mayor does recognize the simplest and the best option to provide comprehensive healthcare to all Americans is realizing the Medicare for All legislation, HR 676 at Capitol Hill. How feasible is that reality? I must say, the most important ingredient necessary to make this possible, is the will of politicians in Congress and the President to guarantee healthcare to all citizens.

Kudos, again to Mayor De Blasio for having the political will and appealing to the collective humanity of Americans. It all started as a firm belief in his compassionate heart and thoughtful mind, that healthcare is not a privilege but a fundamental human right!

Mind is Everything, what you think you become! -Buddha

Tutorial For Trump – Chapter One

Trump’s dishonest healthcare op-ed shows his leadership is the blind leading the visually impaired. The President has no clue about the complexity of the greedy business of American healthcare and needs a tutorial.

Buddha, Papa John’s, Applebee’s and Obamacare

“Anger, ignorance and greed are the three demons in a man’s life.” – Buddha

John Schnatter of Papa John’s Pizza and Zane Tankel, the owner of Applebee’s franchise, said that they would transition some of their fulltime employees to part timejust because of Obamacare. There was a businessmen in Vegas that said he fired some of his employees for the same reason. Another Georgia businessman called C-SPAN and said that he made sure that a couple of workers that he fired, also because of Obamacare, were the ones that voted for Obama. These businessmen are angry with Obama for trying to provide access to affordable quality healthcare for every American. They are barking up the wrong tree.

An artificial knee replacement surgery costs six to ten times less in India than a comparable quality surgery in America and also includes two weeks of home physical therapy after surgery.

Many of these businessmen say they would like to provide healthcare to all their employees only if healthcare is less expensive. That’s the crux of the problem; escalating healthcare costs. I have been practicing neurosurgery in Flint, Michigan, for 16 years and I know how GM got bankrupted partly by the skyrocketing healthcare costs. Last year, my father underwent a knee replacement in India, operated by an Orthopedic surgeon trained in England, using an artificial joint prosthesis from an American medical device company, DePuy. The total cost of the surgery including four days of private room and two weeks of physical therapy cost me less than $8000. The same surgery cost on average of $160,000 in Texas, in 2009 and still costs $45,000 to $70,000 across the country.

Most of the businessmen that are upset with the Affordable Care Act are unfortunately ignorant of the real, deep-rooted cause that is destroying healthcare in America. J. Patrick Rooney and Dan Perrin, architects of Health Savings Accounts during the George W. Bush era, wrote in their book, America’s Health Care Crisis Solved and I quote;

“The problem is greed. The ship has lost its moral rudder. It is awash in greed. We can’t expect the industry to fix itself. There’s just too much self-interest at stake. We can exhort our health care providers to charge less, but we doubt that will work. The money is too easy, and the greed too strong.”
It is ironic that greed, the essence of unregulated capitalism that creates millionaires and billionaires, is also responsible for pushing the middle class into poverty and creating many of the poor in the current economy.
The healthcare industry has not been immune to that greed. Clearly, healing the sick in America has become a mega business, costing the nation $2.8 Trillion to be precise. I don’t find it surprising at all, for America’s business is business. Instead of being angry with Obamacare, the emphasis should be in bringing down the costs of the healthcare business which has created a medical industrial complex that is highly profit oriented, driven by greed and perpetuated by a corrupt political system and benefits mostly the special interests. I am not sure if the owners of Papa John’s or Applebee’s will be in favor of voluntary implementation of less greedy practices or mandatory laws to prevent such practices in the healthcare industry. That is against the core profit motive of business and will be like shooting one’s own greedy capitalist foot.

Papa John’s would rather pass on the 11 to 14 cent per pizza extra cost of providing healthcare to its employees onto the customers than accept a little less of the $100 million per year profit. I am sure he considers himself a compassionate man because he made some charitable donationsbut I am not sure if Buddha would have called it compassion, when such charity is the money made off of the sweat and tears of the hard working employees that were denied basic healthcare. On the other hand there are businessmen that say, even if one doesn’t provide healthcare to their employees out of compassion or kindness, it makes good business sense to do so, for healthy and happy employees are more productive for the bottom line.

Martin, a part owner of Ian’s Pizza, and owns a handful of pizzerias in Wisconsin, provided healthcare benefits to all his employeeseven before Obamacare mandated the employers to provide healthcare. He did it because he believed that was the right thing to do.

That, I am sure Buddha would have agreed, is a true compassionate businessman.